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患者27岁。因停经36+4周,阴道流水4h,于2010年6月18日入院。患者第1胎妊娠,平素月经规律,末次月经2009年10月7日,预产期2010年7月14日。停经40d出现恶心呕吐等早孕反应,同时测尿妊娠试验阳性。孕70dB超提示:双胎妊娠。孕21周彩超提示:胎头双顶径分别为5.5、3.6cm,体质量约423、186g,此后再未产前检查。入院查体:体温36.5℃,脉搏80次/min,血压100/60mmHg(1mmHg=0.133kPa),腹围90cm,宫高31cm,胎位LSA,胎心130次/min,先露为臀,宫缩不规律,骨盆外测量无异常。肛查:宫颈展平,宫口开大3cm,先露臀S-3,胎膜破,羊水清亮。血常规:白细胞11.4×109/L,中性粒细胞0.78,淋巴细胞0.16,血红蛋白105g/L,血小板139×109/L,血型:B型、RH(+),凝血四项无异常。B超提示:晚孕,宫内活胎,臀位。入院诊断:(1)宫内孕孕1产0孕36+4周临产;(2)臀位;(3)胎膜早破;(4)难免早产;(5)双胎妊娠?(一存活儿、一死胎)。入院后
The patient is 27 years old. Due to menopause 36 +4 weeks, vaginal water 4h, admitted on June 18, 2010. Patients with first-trimester pregnancy, usually menstrual regularity, the last menstruation October 7, 2009, the expected date of July 14, 2010. Nausea and vomiting 40d nausea and other early pregnancy reaction, urine test at the same time test positive. Pregnancy 70dB Super Tip: twin pregnancy. 21 weeks pregnant ultrasound Tip: fetal head biparietal diameter were 5.5,3.6 cm, body mass of about 423,186 g, then no prenatal examination. Admission examination: body temperature 36.5 ℃, pulse 80 beats / min, blood pressure 100 / 60mmHg (1mmHg = 0.133kPa), abdominal circumference 90cm, uterine height 31cm, fetal position LSA, fetal heart rate 130 beats / min, Irregular, no abnormal pelvic measurement. Anal examination: flattening the cervix, cervix open large 3cm, first exposed hip S-3, fetal membrane broken, clear amniotic fluid. Blood routine: white blood cells 11.4 × 109 / L, neutrophils 0.78, lymphocytes 0.16, hemoglobin 105g / L, platelets 139 × 109 / L, blood type: B type, RH (+), coagulation no abnormalities. B-Tip: late pregnancy, intrauterine live births, buttocks. Admission diagnosis: (1) intrauterine pregnancy pregnancy 1 0 pregnant 36 + 4 weeks of labor; (2) breech; (3) premature rupture of membranes; (4) inevitable premature labor; (5) twin pregnancy? Child, a stillbirth). After admission