胎盘-四川大学.PPTVIP

CBL(case based learning) 四川大学华西妇女儿童医院 General condition Name: Zeng XX Age: 36y LMP: not clear G8P1+6: 6 times artificial abortion, 1 time term CS(2004) Admission date : 3/12/2016 Case 1 Chief complain amenorrhea for 8+ months itching for 2+ months vaginal bleeding for 5 hours no fetal movement for 2 hours Case 1 Current pregnant experience Regular menstruation, unclear exact LMP . amenorrhea for about 8+ M. ultrasound estimated early pregnancy 2 m after amenorrhea. No morning sickness during early pregnancy, without regular antenatal care during pregnancy. Feel itching especially during night about 2+ m on both legs, abdomen and chest , without complicating nausea, vomiting or uncomfortable upper abdomen. 5 hrs ago, vaginal bleeding about 50ml with slight abdominal pain, No dizziness, dim eyesight et al. transferred to our hospital immediately by local hospital. On the way of transport , no feeling of fetal movement anymore. Deny abnormal previous medical history Case 1 Situation at admission T:36.5℃, P:64bpm, R:21/min, BP:150/104mmHg, No pale of face (skin), conscious and fluent speaking with doctors Physical examination : (-) Obstetric examination: tender uterus, height of uterus:30cm, abdominal circumference:89cm, ROA, fetal heart beat: not to hear. No obvious vaginal bleeding . Blood test(急诊): WBC 9.1×109/L, N 69.4%,RBC 3.19×1012/L, HB 98g/L, PLT 186×109/L, PT 18.3s, APTT 55.4s, Fg 103mg/L Urine test (急诊)：Glu (++)，Pro (+)，WBC (+)，RBC(-) Case 1 Questions ? What are the common causes of vaginal bleeding during third trimester ? What’s the possible cause of vaginal bleeding for this patient ? What are the common causes of fetal deaths? What’s the most possible reason of fetal death for this patient? What are the diagnosis for this women ? What are the assisted examinations that you suggest to do ? Case 1 患者帅XX，女，41岁。既往体健。 生育史： 1998年 人工流产 1999年 因“难产”在双流某医院剖宫产，女儿，健在 1999年 人工流产 2010年