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37岁。孕3,剖宫取胎1,流产1,存0。因妊娠29周,不规则阴道流血伴上腹疼痛40余天再入院。40天前出现无痛性阴道流血,量较多,继之出现持续性上腹烧灼样疼痛,以剑突下明显。按胃炎治疗无效。经抗炎,止血,安胎等处理,腹痛消失,阴道流血停止1周。2天后又反复出现少量阴道流血,门诊治疗无效,1天前阴道流血突然增多。病后仅感胎儿随母体体位而改变,此外无其他不适。患者6年前因妊娠6个月,中央型前置胎盘大流血而行子宫体部剖宫取胎术。体查:腹部膨隆如足月妊娠,下腹正中有一长约13cm的手术瘢痕,余腹部体征无异常。妇查见少量阴道流血,宫底平剑突,无宫缩,右骶前位,胎心音~×+,126次/分,不规则,音弱。血红蛋白75g/L,白细胞14×10~9/L,中性80％,B超
37 years old. Pregnancy 3, Cesarean section fetus 1, abortion 1, deposit 0. 29 weeks of pregnancy, irregular vaginal bleeding with abdominal pain over 40 days and then admitted to hospital. Painless vaginal bleeding 40 days ago, the amount of more, followed by persistent upper abdominal burning-like pain, to the obvious xiphoid. According to gastritis treatment is invalid. The anti-inflammatory, bleeding, tocolysis and other treatment, abdominal pain disappeared, vaginal bleeding stopped for 1 week. 2 days after repeated a small amount of vaginal bleeding, outpatient treatment is invalid, a sudden increase in vaginal bleeding one day ago. After the disease only affects the fetus with the mother’s body position changes, in addition no other discomfort. 6 years ago, 6 years ago, patients with central placenta previa bleeding line uterine cesarean fetus take fetus surgery. Physical examination: bulging abdomen, such as full-term pregnancy, the middle of the lower abdomen there is a surgical scar about 13cm, no abnormal abdominal signs. Fucha check see a small amount of vaginal bleeding, palace flat pingchong, no contractions, right anterior sacral, fetal heart sound ~ × +, 126 beats / min, irregular, weak voice. Hemoglobin 75g / L, white blood cells 14 × 10 ~ 9 / L, 80% neutral, B ultrasound