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患者女24岁,因2孕1产孕28周,死胎,于1994年9月10日来我院,要求用药物引产.查体:体温36.8℃,脉搏84次/min,血压115/9kPa,心肺未见异常,肝脾未触及。妇检:外阴发育正常,已产型,阴道通畅,有少量暗红色血,宫颈光滑,宫体与妊娠月份不符,双侧附件未触及异常,胎心无。辅助检查:血、尿值均正常范围。B超诊断:死胎畸型儿,经查体和辅助检查确诊后,我院行卡孕栓药物引产,丙酸睾丸酮100mg.每日一次肌注共3天,于第4天9时5分阴道后穹窿上药卡孕栓1枚(1mg),1h后患者开始轻微腹痛,每隔2h上1枚,患者持续腹痛并伴有下坠感于14时20分自然破水呈黄色,有臭味。内诊:宫颈消失,宫口开大2.5cm.嘱咐患者下地活动,15时5分胎儿排出,长约6cm,呈栓状,有眼睛,无四肢及心跳。30min后胎盘也自行排出完整,无残留,出血量不多,共用3枚卡孕栓,观察4h左右未见其它异常。给予益母丸,螺旋霉素等药物口服,催产素20u肌注,2天后病人出院.讨论卡孕栓是全合成前列腺素类新药,用它引产主要是增加外源性前列腺素干扰与孕酮的平衡,而达到引产目的,与丙酸睾丸酮合用,因大量丙睾能抑制垂体和卵巢功能,对抗雌激素,并作用脱膜,使其发生变性坏死,为胎盘脱膜的完整排出创造了条件,二者合用在引产方面具有协助作用。(1995—12—11收稿)
The patient was 24 years old and was admitted to our hospital on September 10, 1994 due to 2 pregnancies, 1 pregnancy and 28 weeks of stillbirth, and requested medical induction of labor. Physical examination: body temperature 36.8 ℃, pulse 84 beats / min, blood pressure 115 / 9kPa, Heart and lung no abnormalities, liver and spleen not touched. Gynecological examination: genital development is normal, has produced type, vaginal patency, a small amount of dark red blood, cervical smooth, Palace and pregnancy month does not match, bilateral attachment did not touch the exception, no fetal heart rate. Auxiliary examination: blood, urine values were normal range. B ultrasound diagnosis: stillbirth malformation children, the physical examination and auxiliary examination confirmed, our hospital card carapace drug induced labor, testosterone propionate 100mg once daily intramuscular for 3 days, on the 4th day after 9:05 vaginal Fornix on the drug card captive suppository 1 (1mg), 1h after the patient began to mild abdominal pain, every 2h on a, the patient continued abdominal pain and accompanied by a sense of falling at 14:20 natural broken water yellow, stinky. Internal consultation: the cervix disappears, cervix open large 2.5cm. Asked the patient to go to activities, 15:50 fetal discharge, about 6cm, was a bolt, eyes, no limbs and heartbeat. Placenta also discharged after 30min complete, no residue, small amount of bleeding, sharing three card pregnant suppository, observed 4h or so no other abnormalities. Given Yimu Pills, spiramycin and other drugs orally, oxytocin 20u intramuscular injection, 2 days after the patient was discharged. Discussion Cathepsin is a fully synthetic prostaglandin drugs, with it induced abortion is mainly to increase the interference of exogenous prostaglandins and progesterone Of the balance, and to achieve the purpose of induction of labor, combined with testosterone propionate, due to a large number of testosterone inhibition of pituitary and ovarian function, anti-estrogen, and the role of delamination, degeneration and necrosis of the complete discharge of placenta created the conditions , The two combined with assistance in the induction of labor. (1995-12-11 Received)