Obstructed labour due to a vesical calculus.
Obstructed labour due to a vesical calculus.
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因膀胱结石导致难产。
作者：
P. Armon
一名25岁女子因难产被送往地区医院。她之前有过四次自然阴道分娩。分娩前她唯一的主诉是妊娠最后四周排尿频繁。诊断为锁定双胞胎，显然是两个头部在骨盆内撞击。但是，一个健康的婴儿（体重3400克）在剖宫产时，发现第二个“头”是一个大的膀胱结石。两天后，病人大小便失禁。四周后，她被转介到乞力马扎罗山基督教医疗中心，取出结石并修复疑似瘘管。阴道检查发现膀胱内有一大块坚硬的肿块，部分阻塞了阴道腔，遮蔽了子宫颈。尿液从阴道流出，但看不到瘘管。唯一的其他异常是左脚下垂。开始矫正理疗。放射学检查证实膀胱内结石及左肾弓钙化。血红蛋白8-9 g dl，血尿素25 mmol （15 mg 100 ml）。尿培养产生了大量的寻常变形杆菌。胸部x线检查正常。静脉肾盂造影显示右侧肾积水和输尿管。左侧没有排泄物（图）。
A 25-year-old wvoman was admitted to a district hospital in obstructed labour. She had previously had four spontaneous vaginal deliveries. Her only complaint before the onset of this labour was of frequency of micturition during the last four weeks of pregnancy. A diagnosis of locked twins was made as apparently two heads wN-ere impacted in the pelvis. But a single, healthy baby (wcight 3400 g) was delivered at lower segment caesarean section, and the second "head" was found to be a large vesical calculus. Two days later the patient became incontinent of urine. She was referred to the Kilimanjaro Christian Medical Centre four wveeks later for removal of the stone and repair of a suspected fistula. Vaginal examination revealed a large, hard mass lying wvithin the bladder partially occluding the vaginal cavity and obscuring the cervix. Urine was pouring down the vagina but the fistula could not be seen. The only other abnormality was a left-sided foot drop. Corrective physiotherapy was started. Radiological examination confirmed an intravesical calculus and calcifications were seen in the left renal arca. Haemoglobin was 8-9 g dl and blood urea 2 5 mmoll (15 mg 100 ml). Urine culture produced a heavy growth of Proteuis vulgaris. Chest x-ray examination was normal. An intravenous pyclogram showed a right hydronephrosis and hydroureter. There wvas no excretion on the left side (figure).