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钱××,已婚,25岁,住院号67829。因停经33周,剧烈腹痛2天,胎动减少1天,以先兆早产于1989年8月29日入院。患者末次月经1989年1月5日,停经早期有早孕反应,停经4月余感胎动,产前检查拟诊为宫内妊娠,来诊时腹痛2天,胎心轻,未破水,头昏。入院检查:T 37℃,P82次,呼吸20次,血压13.3/7.98 kPa。发育正常,营养中等,神志清楚,重度贫血貌。痛苦病容,自动体位,心肺听诊正常。腹部高度膨隆,“宫底”剑下2指,触及胎头、胎儿肢体,胎心音140次/分,略轻,无阴道流血。肛查:宫口未开,胎先露不清,无宫缩。血红蛋白65 g/L,红细胞末查,白细胞总数5×10~9/L,N0.88,L0.12。B超示肩右后,双顶径8.9cm,胎心、胎动好,后壁胎盘厚约8 cm,胎盘GI级。初诊孕:
Money × ×, married, 25 years old, hospital number 67829. Due to menopause 33 weeks, 2 days of severe abdominal pain, fetal movement decreased by 1 day, with threatened premature delivery on August 29, 1989 admission. Patients with the last menstrual January 5, 1989, early menopause early pregnancy response, menopause in April feels fetal movement, prenatal diagnosis of intrauterine pregnancy to be diagnosed, to diagnose abdominal pain for 2 days, fetal heart rate is light, not broken water, dizziness. Admission examination: T 37 ℃, P82 times, breathing 20 times, blood pressure 13.3 / 7.98 kPa. Normal development, moderate nutrition, conscious, severe anemia appearance. Painful, automatic position, cardiopulmonary auscultation normal. Abdominal bulge, "Palace at the bottom of the sword 2 refers to the fetal head, fetal limb, fetal heart sound 140 beats / min, slightly light, no vaginal bleeding. Anal examination: cervix is not open, the first fetal unclear, no contractions. Hemoglobin 65 g / L, the end of red blood cell check, the total white blood cells 5 × 10 ~ 9 / L, N0.88, L0.12. B ultrasound showed shoulder right, biparietal diameter 8.9cm, fetal heart rate, fetal movement, posterior wall thickness of about 8 cm placenta, GI level. First trimester pregnancy: