患者女,31岁。第二胎妊娠7个月,高烧,剧烈腹痛15小时,于1982年7月18日零点30分入院。入院前1天上午突然持续性下腹痛,阵发性加剧,约4小时后高烧,无头痛、恶心、寒战。尿少,未排气排便。无阴道出血及下坠感。既往健康。月经规律,白带多,无臭味,末次月经不详。孕期一直有性生活史,无坐浴盆浴等情况。本孕期顺利,两年前曾做剖腹产,现有一子。检查:体温39.5℃,脉搏98次,血压110/60。神志清,急性痛苦病容,辗转不安,心肺正常,腹胀。腹肌紧张,全腹压痛明显,有反跳痛,肝脾未触及。肝浊音界存在,肠鸣音消失。子宫底位于脐上3横指,胎位枕右前,胎心154次/分。有不规律宫缩。妇科检查:阴道内有少量暗红色分泌物,无特殊气味。宫颈管未消失,可容一指。头先 Female patient, 31 years old. The second trimester of pregnancy 7 months, high fever, severe abdominal pain 15 hours, at July 30, 1982 at 0:30 admission. One day before admission, a sudden persistent lower abdominal pain, paroxysmal agitation, about 4 hours after the high fever, no headache, nausea, chills. Less urine, no defecation. No vaginal bleeding and falling sense. Past health. Menstrual regularity, vaginal discharge, no odor, the last menstruation unknown. Pregnancy has been a history of sexual life, no bidet bath and so on. The pregnancy is smooth, caesarean section two years ago, there is a son. Check: body temperature 39.5 ℃, pulse 98 times, blood pressure 110/60. Conscious, acute and painful, twitchy, normal heart and lungs, bloating. Abdominal tension, full abdominal tenderness, rebound pain, liver and spleen not touched. Liver dullness sector exists, bowel sounds disappear. End of the uterus is located on the umbilical 3 horizontal fingers, fetal front pillow, fetal heart rate 154 times / min. There are irregular contractions. Gynecological examination: a small amount of dark red vaginal discharge, no special smell. Cervical tube does not disappear, can accommodate one means. First of all