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患女,38岁,以闭经16周,下腹痛2d 主诉入院。停经后有早孕反应,近5d 自感胎动,入院前2d 感下腹痛并下坠感,恶心头晕。孕5产4,曾有2次徒手剥离胎盘史,1次清宫史,产时出血多。查体:血压测不到,两肺可闻及干湿鸣,心(-),下腹压痛及反跳痛。妇科检查:阴道通畅,后穹窿饱满,触痛,宫颈着色举痛,子宫未查清。行剖腹操查,见腹腔出血约1000ml,有一约14cm 长之男性胎儿,子宫底部有7cm 长之裂口,胎盘植入子宫肌层,行子宫次全切除术。病理诊断:胎盘植入,子宫底部破裂。
Suffering from women, 38 years old, to amenorrhea for 16 weeks, abdominal pain 2d main admission. Postmenopausal pregnancy response, spontaneous fetal movement in the past 5d, 2d before admission lower abdominal pain and feeling of falling, nausea and dizziness. Pregnancy 5 4, there have been 2 hand stripping placental history, a history of the Qing, multiple intrapartum hemorrhage. Physical examination: blood pressure can not be measured, both lungs can smell and dry and wet Ming, heart (-), abdominal tenderness and rebound tenderness. Gynecological examination: vaginal patency, after the fornix full, tenderness, cervical pain, pain, uterus not identified. Line laparotomy, see about 1000ml of abdominal bleeding, there is a male fetus about 14cm long, 7cm long at the bottom of the uterus of the gap, the placenta implanted in the myometrium, line subtotal hysterectomy. Pathological diagnosis: placenta accreta, rupture of the bottom of the uterus.