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分娩第三产程对胎盘粘连处理不当致急性子宫内翻是产科严重并发症。我院1986年10月收治一例误将内翻的子宫与粘连的胎盘一并暴力扭转,使子宫断裂、离体。现报告如下。患者33岁,住院号0259864。于1986年10月31日由接生员在家中接产,胎儿娩出后胎盘不剥离,产后1小时阴道突然出血约1000ml,随即意识不清,经牵拉脐带按压下腹,胎盘仍未排出。服下中药后意识稍好转,又反复牵拉脐带,强力挤压子宫数次,见胎盘样组织部分娩出,反复将其钳夹向下扭转,致患者痛苦难忍,遂将胎盘样组织扭掉。当时无活动性出血,但有条索状脂肪样物脱出宫口。查扭取下组织为胎盘粘附在一红色袋状物上,将其分离。因病情危重于当日晚将病人送至我院。患者既往体健,孕7产5,末两次分娩均发生胎盘粘连。查体:患者面色苍白,神志尚清,Bp60/30mmHg,R36次/分,心率120次/分。腹软,无移动性浊音,下腹压痛明显,无阴道出血,似大网膜样组织脱出阴道口处不易辨认。查被扭掉之组
Third stage of labor on the placenta accreta improper handling of acute uterine inversion is a serious obstetric complications. In our hospital in October 1986, a case of mistakenly inverting the uterus and adhesion of the placenta together with violence to reverse the uterine rupture, isolated. The report is as follows. Patient 33 years old, hospital number 0259864. On October 31, 1986 by a midwife at home, the fetus does not peel the placenta after delivery, sudden vaginal bleeding about 1 hour postpartum about 1000ml, then unconsciousness, by pressing the lower abdomen umbilical cord, the placenta has not yet been discharged. Subconsciously after taking the medicine consciousness improved, but also repeatedly pull the umbilical cord, strong squeeze the uterus several times, see the placenta-like tissue part of the delivery, repeatedly clamp down to reverse, causing painful patients, then the placenta-like tissue twisted off . There was no active bleeding at the time, but there was a cord-like fat-like substance that had escaped from the cervix. Check the twist to remove the tissue attached to the placenta on a red bag, the separation. Due to critical condition on the same day the patient was sent to our hospital. In the past, patients with healthy body weight, pregnancy 5 5, the last two deliveries have occurred placental adhesions. Physical examination: patients pale, conscious Shangqing, Bp60 / 30mmHg, R36 times / min, heart rate 120 beats / min. Abdominal soft, no mobility dullness, abdominal tenderness obvious, no vaginal bleeding, like omentum-like tissue prolapse vaginal mouth is not easy to identify. Check the group was writhing