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患者鲍××,26岁,女,住院号812770.第一胎.孕37周。因无痛性阴道出血3天而入院。检查:神志清,血压120/80mm Hg,心率72/次/分。两肺呼吸音粗,未闻及罗音。腹隆,肝脾未触及。宫底剑突下3横指。先露头,未衔接,胎位左枕前位,胎心148次/分。未作阴道检查。入院时有少量阴道出血,作止血保守治疗。入院后10小时,突然有多量阴道出血,宫口未开,诊断为前置胎盘。即在硬膜外麻醉下作子宫下段剖腹产。手术过程中,在娩出胎儿、胎盘后,子宫收缩无力,子宫下段胎盘附着面大量出血,经宫壁肌注催产素二次,每次15单位,并按摩子宫,局部用纱布压迫止血均无效.患者面色苍白,烦躁不安,血压由手术开始时110/70急剧下降至40/20。立即在输液、间接输血、吸氧的同时,迅速结扎双侧子宫动脉上行支。结扎后,出血立即被控制,
Patient Bao × ×, 26 years old, female, hospital number 812770. The first child. Pregnant 37 weeks. Due to painless vaginal bleeding for 3 days and admitted to hospital. Check: delirious, blood pressure 120 / 80mm Hg, heart rate 72 / time / min. Breath sounds rough two lungs, did not hear and rales. Abdominal, liver and spleen not touched. Palace under the sword suddenly 3 horizontal refers to. The first outcrop, not convergence, fetal left anterior occipital position, fetal heart rate 148 beats / min. No vaginal examination. A small amount of vaginal bleeding on admission, conservative treatment for bleeding. 10 hours after admission, suddenly a large number of vaginal bleeding, cervix is not open, the diagnosis of placenta previa. That is, under epidural anesthesia for lower uterine caesarean section. Surgical procedure, after the delivery of the fetus, placenta, uterine contractions weakness, the lower part of the placenta attached to a large number of bleeding, intrauterine intramuscular injection of oxytocin twice, each 15 units, and massage the uterus, local gauze pressure to stop bleeding are ineffective. The patient was pale and irritable, with blood pressure dropping sharply to 40/20 from 110/70 at the start of surgery. Immediate infusion, indirect blood transfusion, oxygen at the same time, rapid ligation of bilateral uterine artery upstream branch. After ligation, bleeding was immediately controlled,