论文部分内容阅读
患者28岁,孕_2产_1,孕40周,下腹阵痛破水1h,凌晨急诊入院。第一胎足月妊娠,曾因头盆不称行子宫下段剖宫产术,新生儿窒息经抢救无效死亡。产妇腹壁伤口感染Ⅱ期愈合出院。产后4个月再次受孕,妊娠6个月来院检查:宫底脐上一指,原切口疤痕处可见肠形、触及肠管、叩诊鼓音、妊娠子宫部分从切口疝囊突出。腹壁因摩擦溃烂不愈至临产。入院体查:全身一般情况可,下腹部原瘢痕处有鹅蛋大小溃烂面,有脓性分泌物、恶臭;宫底剑突下一指,臀位,先露高浮,胎心音每分钟148次;消毒下阴道检查:宫颈于耻骨联合上触及困难。羊水清亮。入院诊断:①宫内足月妊娠,临产;②臀位早破水;③腹壁切口疝合并腹壁溃疡;④瘢痕子宫。准备在硬膜外麻醉下行腹壁溃疡切除、剖宫产及切口疝修补术。
Patient 28 years old, pregnancy _2 _1 production, 40 weeks pregnant, abdominal pain burst Broken 1h, early morning admission. The first full-term pregnancy of the fetus, was due to cephalopelvic lower uterine cesarean section, neonatal asphyxia died after treatment. Maternal abdominal wound infection Ⅱ healed discharged. 4 months after childbirth again pregnancy, 6 months of pregnancy to check: a uterus on the uterus, the original incision scar visible at the bowel, touching the bowel, percussion drum sound, part of the uterus from the incision hernia sac prominence. Abdominal wall due to friction ulceration to abortion. Admission physical examination: the general condition of the body may be, the lower abdomen of the original scars oval size ulceration, purulent secretions, stench; Palace under the xiphoid a finger, breech, first exposed high float, fetal heart sound per minute 148 times; disinfection under the vaginal examination: the cervix touches on the pubic symphysis difficulties. Amniotic fluid clear. Admission diagnosis: ① intrauterine term pregnancy, labor; ② breech broken water; ③ abdominal incisional hernia with abdominal wall ulcer; ④ scar uterus. Prepare epidural anesthesia for abdominal wall ulcer resection, cesarean section and incisional hernia repair.