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患者,女,30岁,主因“双胎妊娠29周+6,发现双胎生长不一致,血压升高1天”于2015-04-24收入院。患者平素月经规律,4/28d,量中,无痛经,末次月经2014-09-27,自然受孕。基础血压120/80mm Hg。孕早期B超提示单绒毛膜双胎。妊娠19周+4B超提示两胎儿未见明显畸形,双胎发育均与孕周相符。OGTT正常。患者入院当日2次测量血压均为140/90 mmHg,偶有头晕,无头痛、眼花,尿蛋白(+)。既往体健,否认高血压、糖尿病等病史。G3P1,5年前剖宫产1次。入院后B超:宫内孕双活胎,大胎儿头位,相当于30周~(+4),估计体质量1 533g,RI=0.52,S/D=2.1,膀胱大小2.28cm×1.58cm,羊水最大深度5.1cm,胎儿二尖瓣反流(中度),三尖瓣反流(中度);小胎儿臀位,相当于26周~(+1),估计体质量784g,RI=0.68,S/D=3.11,膀胱大小1.43cm×1.93cm,羊水指数4.3cm,脐绕颈1周。入院诊断:G3P1宫内孕29周+6,双胎妊娠,头臀位;单绒毛膜性双胎选择性胎儿生长受限,I型;轻度子痫前期;瘢痕子宫。
Patients, female, 30 years old, mainly due to “twin pregnancy 29 weeks +6, found inconsistent twins growth, blood pressure increased by 1 day” in 2015-04-24 income hospital. Patients usually menstrual regularity, 4 / 28d, volume, no dysmenorrhea, the last menstrual 2014-09-27, natural conception. Base blood pressure 120 / 80mm Hg. Early pregnancy B-prompt single chorionic twins. 19 weeks of gestation + 4B ultrasound showed no significant deformity of the two fetuses, twins were consistent with gestational age. OGTT normal. Patients were measured on the day of 2 times the blood pressure were 140/90 mmHg, occasional dizziness, no headache, vertigo, urinary protein (+). Past physical health, denied high blood pressure, diabetes and other medical history. G3P1 5 years ago abdomen 1 times. B ultrasound after admission: intrauterine pregnancy double live births, big fetus head position, equivalent to 30 weeks ~ (+4), estimated body weight 5353g, RI = 0.52, S / D = 2.1, bladder size 2.28cm × 1.58cm , The maximum depth of amniotic fluid 5.1cm, fetal mitral regurgitation (moderate), tricuspid regurgitation (moderate); small fetal breech, equivalent to 26 weeks ~ (+1), estimated body mass 784g, RI = 0.68, S / D = 3.11, bladder size 1.43cm × 1.93cm, amniotic fluid index 4.3cm, umbilical neck 1 week. Admission diagnosis: G3P1 intrauterine 29 weeks +6, twin pregnancy, head and breech; monochorionic twins selective fetal growth restriction, type I; mild preeclampsia; scar uterus.