每日一题_2023.09.27

A 19-year-old mother of two rushes to her obstetrician’s office at 35 weeks’ gestation because of cramping abdominal pain and mild vaginal bleeding. Both cramps and bleeding started about two hours ago. Pain is constant, with intermittent episodes of severe cramping. Bleeding has been sufficient to soak through four to five pads within the past few hours. She denies a history of trauma or leakage of clear fluid. She does admit to using cocaine three times within the past month, most recently last night. She is afebrile, blood pressure is 155/95 mm Hg, and heart rate is 100/min. Bi-manual examination reveals tenderness over the fundus and a nondilated cervix. Ultrasound reveals a normally implanted placenta with no visible abnormalities. Fetal heart rate is in the 170-180/min range. Which of the following is the most likely diagnosis?

一名有两个孩子的19岁母亲在怀孕35周时，因为腹痛和少量阴道出血，匆忙赶到产科医生的办公室。抽筋和出血都是两小时前开始的。疼痛是持续性的，伴有间歇性的严重痉挛。在过去的几小时内，出血量足以浸透四到五个垫子。她否认有外伤史或透明液体渗漏。她承认在过去的一个月里吸食了三次可卡因，最近一次是昨晚。患者无发热，血压155/95 mmhg，心率100/min。双手检查发现眼底压痛和宫颈不扩张。超声显示胎盘正常植入，无明显异常。胎心率在170-180/分钟范围内。下列哪一项是最可能的诊断?

(A) Abruptio placentae 胎盘早剥

(B) Concealed abruption 隐匿性剥脱

(C) Labor 分娩

(D) Placenta accreta侵入性胎盘

(E) Placenta previa前置胎盘

答案解析：

胎盘早剥的典型表现是出血、子宫收缩和胎盘与子宫过早分离引起的疼痛，尽管胎盘植入在正常位置。最常由基底蜕膜中有缺陷的母体血管破裂引起。由于已知的高血压和使用可卡因，该患者发生胎盘早剥的风险高。其他危险因素包括脐带短、创伤、早剥、吸烟、子宫肌瘤、高龄、未完成子宫减压术、未足月胎膜早破和出血倾向。虽然超声可以显示胎盘早剥，但它不是很敏感，仅在分娩时证实的胎盘早剥病例中有25%为阳性。

正确答案：A