问题 问答题

试述骨盆狭窄的诊断及处理原则。

答案

参考答案:狭窄骨盆的诊断如下所述: (1)病史:有无伤楼病、脊髓灰质炎、脊柱和髓关节结核以及外伤史。若为经产妇,既往有无难产史及原因、新生儿有无产伤等。(2)一般检查:测量身高不足145cm应警惕均小骨盆。观察孕妇体型,步态有无破足,有无脊柱及髓关节畸形,米氏菱形窝是否对称,有无尖腹及悬垂腹等。(3)腹部检查:1)观察腹型;2)检查有无胎位异常;3)估计头盆关系:检查胎头跨耻征。 (4)骨盆测量:1)骨盆外测量:各径线小于正常值2cm或以上为均小骨盆;骶耻外径小于18cm为扁平骨盆;坐骨结节间径小于8cm、耻骨弓小于90°为漏斗骨盆;骨盆两侧斜径及同侧直径相差大于1cm为偏斜骨盆。2)骨盆内测量:对角径小于11.5cm,骶岬突出为扁平骨盆;坐骨棘间径小于10cm,坐骨切迹宽度小于两横指;骨结节间径小于8cm,骨结节间径与出口后矢状径之和小于15cm。 狭窄骨盆分娩时的处理如下:(1)一般处理:安慰产妇,保证营养及水分的摄入,必要时补液。监测宫缩,勤听胎心,检查胎先露部下降及宫口扩张程度。(2)骨盆入口平面狭窄的处理:①明显头盆不称,骶耻外径石超过16.0cm,骨盆入口前后径不超过8.0cm,胎头跨耻征阳性者,足月活胎不能入盆,不能经 * * 分娩,临产后行副宫产术结束分娩。②轻度头盆不称:能耻外径为16.5~17.5cm,骨盆入口前后径为8.5~9.5cm,胎头跨耻征可疑阳性。足月活胎体重不足3000g,胎心率正常,应在严密监护下试产。(3)中骨盆及骨盆出口平面狭窄的处理:若宫口开全,胎头双顶径达坐骨棘水平或更低,可经 * * 助产。若胎头双顶径未达坐骨棘水平,或出现胎儿窘迫征象,应行剖宫产术结束分娩。诊断为骨盆出口狭窄,不应进行试产。临床上常用出口横径与出口后矢状径之和大于15cm,可经 * * 分娩。若两者之和小于15cm,足月胎儿不易经 * * 分娩,应行副宫产术结束分娩。(4)骨盆三个平面狭窄的处理:主要是均小骨盆。若胎儿不大,胎位正常,头盆相称,宫缩好,可以试产;若胎儿较大,有明显头盆不称,胎儿不能通过产道,应尽早行剖宫产术。(5)畸形骨盆的处理:畸形严重、明显头盆不称者,应及时行剖宫产术。

完形填空
完形填空。
     Jane is a nice girl and likes small animals.On   1   way back from school every afternoon.She always
stops   2   the animals in the pet(宠物)shop.She likes to see the dogs.One of them is a little white dog,
and Jane likes it   3   .She   4   the dog   5    in the window of the pet shop.She is very interested in(感兴趣) it.She often forgets the time. So she comes home very   6   .
       One day her parents asked   7   she was late.Jane told them about the dog in the pet shop.
       The next day Jane stopped to look   8   the window of the pet shop,but she could not  9   the dog.
She was very sad(伤心) and went home early.
     Where she   10    home,her mother showed her a big cake and her father gave her the little white
dog from the pet shop.It was her birthday.Jane was very glad.From that day,she did not come late.
She ran home early to play with the little white dog.
( )1. A.she
( )2. A.looking at
( )3. A.very many
( )4. A.watches
( )5. A.to play
( )6. A.late
( )7. A.what
( )8. A.at
( )9. A.looked 
B.hers    
B.looks at
B.very much
B.watch    
B.play     
B.early    
B.why  
B.to                
B.looked at 
C.his      
C.to look at
C.very      
C.see      
C.played    
C.fast      
C.when         
C.into            
C.arrived in
D.her        
D.looked at  
D.many        
D.saw        
D.plays      
D.soon        
D.where      
D.out        
D.arrived at                
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