论文部分内容阅读
本文报告了1例因自然分娩后3天胎盘未排出,由外院转入我院患者的诊治情况。查体见贫血貌,子宫复旧不佳,阴道少量出血。急查血常规,血红蛋白(HGB)88g/L,人绒毛膜促性腺激素(HCG)7953 mU/ml。超声检查宫腔及宫颈管内可见16.2cm×8.3cm×5.4cm稍高回声,似胎盘样组织,与宫腔前壁分界清晰,与后壁底部分界欠清,内可见多条血流信号;宫底肌层较薄。诊断为胎盘植入、产后贫血及低蛋白血症。患者坚决要求保留子宫。遂给予60mg甲氨蝶呤肌内注射1次,同时行抗感染、纠正贫血及促宫缩治疗。次日复查HCG 3208mU/ml,导管室内行子宫动脉栓塞术。栓塞后造影检查提示双侧子宫动脉分支闭塞完全。术后复查HCG 1756.88mU/ml;复查超声,提示胎盘残留。遂行清宫术,术后继续给予抗感染、促宫缩治疗。清宫术后病情平稳,遂出院。嘱患者定期复查HCG和超声,坚持随诊。
This article reports the diagnosis and treatment of 1 patient who was transferred to our hospital from 3 days after spontaneous delivery without discharge. Check the body to see anemia, poor uterine involution, a small amount of vaginal bleeding. Urgent blood test, hemoglobin (HGB) 88g / L, human chorionic gonadotropin (HCG) 7953 mU / ml. Ultrasound examination of the uterine cavity and cervical canal can be seen 16.2cm × 8.3cm × 5.4cm slightly hyperechoic, placental like tissue, and the uterine anterior clear boundaries, and the bottom wall of the posterior wall less clear, showing multiple blood flow signals; Palace The bottom muscle thinner. Diagnosis of placenta accreta, postpartum anemia and hypoproteinemia. Patients strongly require retention of the uterus. Then given 60mg methotrexate intramuscular injection 1, at the same time anti-infection, to correct anemia and uterine contractions. The next day HCG 3208mU / ml, catheter uterine artery embolization. Post embolization angiography prompted bilateral uterine artery occlusion complete. Postoperative HCG 1756.88mU / ml review; review of ultrasound, suggesting placental residue. Carry out curettage, continue to give anti-infection after surgery, and promote contractions. Clear postoperative condition was stable, then discharged. Zhu Huanzhe periodic review of HCG and ultrasound, adhere to follow-up.