1例双胎妊娠合并前置胎盘第二胎延迟分娩患者的围产期护理

Perinatal nursing care of a patient with twin pregnancy and delayed delivery of the second fetus with placenta previa

总结1例双胎妊娠合并前置胎盘患者第二胎延迟分娩27 d的围产期护理经验,护理要点如下。延迟分娩期间启动高危预警,警惕前置胎盘大出血;有效预防感染,降低母体败血症、绒毛膜羊膜炎的发生率;积极抑制宫缩以延长孕周,提高第二胎儿的围生期存活率;加强胎儿宫内监护,早期识别胎儿窘迫征象;实施个性化的心理护理,保障患者心理健康。产时完善抢救预案,确保母婴安全。产后积极防治大出血,预防产褥感染。经过79 d的积极治疗和精心护理,患者未发生感染和大出血,产后痊愈出院;延迟分娩的第二胎儿出生后59 d顺利出院,随访至纠正月龄1个月体格检查达标,生长发育良好。

To summarize the experience of perinatal nursing for 27 days of delayed delivery of the second fetus of a twin pregnancy with placenta previa.Key nursing points include:the start of high risk warning during delayed delivery,and being alert to placenta previa hemorrhage;effective prevention of infection,reducing the incidence of maternal sepsis and chorioamnionitis;actively inhibiting the contractions to prolong gestational age and improving the perinatal survival rate of the second fetus;strengthening in utero fetal monitoring,identifying the early signs of fetal distress;targeted implementation of personalized psychological nursing,to ensure the mental health of patients.The rescue plan during delivery should be improved to ensure the safety of mother and child.Postpartum prevention and treatment of massive bleeding was actively conducted,as well as the prevention of puerperal infection.After 79 d of active treatment and intensive nursing care,the patient was treated and discharged from the hospital without any signs of infection or a massive bleeding.The second newborn,whose delivery was delayed,was discharged from the hospital 59 d after birth,and the follow up was continued for a month until the reach to the standard growth development parameters and the overall physical examination was good.