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第一次临床讨论学生甲我首先考虑是过期流产。本例病史有停经、厌食、恶心、呕吐等早孕反应;妇科检查子宫增大,符合妊娠。现停经5个月,提重物后出现少量阴道流血,应考虑流产。此例停经已22周,从未感觉胎动,妇查子宫比停经月份小,宫颈口未开;超声检查无胎心、胎动反射,因此考虑过期流产。学生乙过期流产是指胚胎死亡2个月以上尚未自然排出者。本例在停经2个月及4个月时曾作妇科检查,子宫增大符合停经月份,说明胎儿在停经4月时尚在正常发育。现在停经5个月,子宫约4月妊娠大小,提示在末次检查之后胎儿死亡,子宫不再增大,反渐缩小,亦即胎儿宫内死亡约1个月左右,不符合过期流产定义。我认为诊断是:宫内妊娠5个月,胎儿已死亡。
The first clinical discussion of student A I first considered expired abortion. This case history of menopause, anorexia, nausea, vomiting and other early pregnancy reactions; gynecological examination of the uterus increases, in line with pregnancy. Now stop menstruation 5 months, heavy objects after a small amount of vaginal bleeding, abortion should be considered. This case of menopause has been 22 weeks, has never felt fetal movement, women’s uterus than the menopause, small months, the cervix is not open; no fetal heart rate ultrasound, fetal movement, so consider the abortion. Student B abortion refers to the embryo died more than 2 months have not been naturally discharged. In this case menopause 2 months and 4 months when gynecological examination, uterus increases in line with menopause, indicating that the fetus during normal menopause April fashion. Menopause now 5 months, the uterus about the size of the pregnancy in April, suggesting that after the last examination, the fetus died, the uterus is no longer increased, anti-tapering, that is, fetal death within about 1 month, does not meet the definition of late abortion. I think the diagnosis is: 5 months of intrauterine pregnancy, the fetus has died.