Conservative Management of Placenta Accreta in a Multiparous Woman
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Macroeconomics R. GLENN HUBBARD COLUMBIA UNIVERSITY ANTHONY PATRICK O’BRIEN LEHIGH UNIVERSITY MATTHEW RAFFERTY QUINNIPIAC UNIVERSITY Boston Columbus Indianapolis New York San Francisco Upper Saddle RiverAmsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City So Paulo Sydney Hong Kong Seoul Singapore Taipei TokyoAbout the AuthorsGlenn Hubbard Professor Researcher and Policymaker R. Glenn Hubbard is the dean and Russell L. Carson Professor of Finance and Economics in the Graduate School of Business at Columbia University and professor of economics in Columbia’s Faculty of Arts and Sciences. He is also a research associate of the National Bureau of Economic Research and a director of Automatic Data Processing Black Rock Closed- End Funds KKR Financial Corporation and MetLife. Professor Hubbard received his Ph.D. in economics from Harvard University in 1983. From 2001 to 2003 he served as chairman of the White House Council of Economic Advisers and chairman of the OECD Economy Policy Commit- tee and from 1991 to 1993 he was deputy assistant secretary of the U.S. Treasury Department. He currently serves as co-chair of the nonpar-tisan Committee on Capital Markets Regulation and the Corporate Boards Study Group. ProfessorHubbard is the author of more than 100 articles in leading journals including American EconomicReview Brookings Papers on Economic Activity Journal of Finance Journal of Financial EconomicsJournal of Money Credit and Banking Journal of Political Economy Journal of Public EconomicsQuarterly Journal of Economics RAND Journal of Economics and Review of Economics and Statistics.Tony O’Brien Award-Winning Professor and Researcher Anthony Patrick O’Brien is a professor of economics at Lehigh University. He received a Ph.D. from the University of California Berkeley in 1987. He has taught principles of economics money and banking and interme- diate macroeconomics for more than 20 years in both large sections and small honors classes. He received the Lehigh University Award for Distin- guished Teaching. He was formerly the director of the Diamond Center for Economic Education and was named a Dana Foundation Faculty Fel- low and Lehigh Class of 1961 Professor of Economics. He has been a visit- ing professor at the University of California Santa Barbara and Carnegie Mellon University. Professor O’Brien’s research has dealt with such issues as the evolution of the U.S. automobile industry sources of U.S. economiccompetitiveness the development of U.S. trade policy the causes of the Great Depression and thecauses of black–white income differences. His research has been published in leading journals in-cluding American Economic Review Quarterly Journal of Economics Journal of Money Credit andBanking Industrial Relations Journal of Economic History Explorations in Economic History andJournal of PolicyHistory.Matthew Rafferty Professor and Researcher Matthew Christopher Rafferty is a professor of economics and department chairperson at Quinnipiac University. He has also been a visiting professor at Union College. He received a Ph.D. from the University of California Davis in 1997 and has taught intermediate macroeconomics for 15 years in both large and small sections. Professor Rafferty’s research has f ocused on university and firm-financed research and development activities. In particular he is interested in understanding how corporate governance and equity compensation influence firm research and development. His research has been published in leading journals including the Journal of Financial and Quantitative Analysis Journal of Corporate Finance Research Policy and the Southern Economic Journal. He has worked as a consultantfor theConnecticut Petroleum Council on issues before the Connecticut state legislature. He has alsowritten op-ed pieces that have appeared in several newspapers including the New York Times. iii Brief Contents Part 1: Introduction Chapter 1 The Long and Short of Macroeconomics 1 Chapter 2 Measuring the Macroeconomy 23 Chapter 3 The Financial System 59 Part 2: Macroeconomics in the Long Run: Economic Growth Chapter 4 Determining Aggregate Production 105 Chapter 5 Long-Run Economic Growth 143 Chapter 6 Money and Inflation 188 Chapter 7 The Labor Market 231 Part 3: Macroeconomics in the Short Run: Theory and Policy Chapter 8 Business Cycles 271 Chapter 9 IS–MP: A Short-Run Macroeconomic Model 302 Chapter 10 Monetary Policy in the Short Run 363 Chapter 11 Fiscal Policy in the Short Run 407 Chapter 12 Aggregate Demand Aggregate Supply and Monetary Policy 448 Part 4: Extensions Chapter 13 Fiscal Policy and the Government Budget in the Long Run 486 Chapter 14 Consumption and Investment 521 Chapter 15 The Balance of Payments Exchange Rates and Macroeconomic Policy 559 Glossary G-1 Index I-1ivContentsChapter 1 The Long and Short of Macroeconomics 1WHEN YOU ENTER THE JOB MARKET CAN MATTER A LOT ........................................................ 11.1 What Macroeconomics Is About........................................................................... 2 Macroeconomics in the Short Run and in the Long Run .................................................... 2 Long-Run Growth in the United States ............................................................................. 3 Some Countries Have Not Experienced Significant Long-Run Growth ............................... 4 Aging Populations Pose a Challenge to Governments Around the World .......................... 5 Unemployment in the United States ................................................................................. 6 How Unemployment Rates Differ Across Developed Countries ......................................... 7 Inflation Rates Fluctuate Over Time and Across Countries................................................. 7 Econo mic Policy Can Help Stabilize the Economy .. (8)International Factors Have Become Increasingly Important in Explaining Macroeconomic Events................................................................................. 91.2 How Economists Think About Macroeconomics ............................................. 11 What Is the Best Way to Analyze Macroeconomic Issues .............................................. 11 Macroeconomic Models.................................................................................................. 12Solved Problem 1.2: Do Rising Imports Lead to a Permanent Reductionin U.S. Employment. (12)Assumptions Endogenous Variables and Exogenous Variables in EconomicModels ........................................................................................................ 13 Forming and Testing Hypotheses in Economic Models .................................................... 14Making the Connection: What Do People Know About Macroeconomicsand How Do They KnowIt .............................................................................................. 151.3 Key Issues and Questions of Macroeconomics ............................................... 16An Inside Look: Will Consumer Spending Nudge Employers to Hire................................ 18Chapter Summary and Problems ............................................................................. 20 Key Terms and Concepts Review Questions Problems and Applications Data Exercise Theseend-of-chapter resource materials repeat in all chapters.Chapter 2 Measuring the Macroeconomy 23HOW DO WE KNOW WHEN WE ARE IN ARECESSION ........................................................... 23Key Issue andQuestion .................................................................................................... 232.1 GDP: Measuring Total Production and Total Income ..................................... 25 How theGovernment Calculates GDP (25)Production and Income (26)The Circular Flow of Income (27)An Example of Measuring GDP (29)National Income Identities and the Components of GDP (29)vvi CONTENTS Making the Connection: Will Public Employee Pensions Wreck State and Local Government Budgets.................................................................... 31 The Relationship Between GDP and GNP........................................................................ 33 2.2 Real GDP Nominal GDP and the GDP Deflator.............................................. 33 Solved Problem 2.2a: Calculating Real GDP . (34)Price Indexes and the GDP Deflator (35)Solved Problem 2.2b: Calculating the Inflation Rate ..........................................................36 The Chain-Weighted Measure of Real GDP ....................................................................37 Making the Connection: Trying to Hit a Moving Target: Forecasting with “Real-Time Data” .................................................................................. 37 Comparing GDP Across Countries................................................................................... 38 Making the Connection: The Incredible Shrinking Chinese Economy ................................ 39 GDP and National Income .............................................................................................. 40 2.3 Inflation Rates and Interest Rates ....................................................................... 41 The Consumer Price Index .............................................................................................. 42 Making the Connection: Does Indexing Preserve the Purchasing Power of Social Security Payments ................................................................ 43 How Accurate Is theCPI ............................................................................................... 44 The Way the Federal Reserve Measures Inflation ............................................................ 44 InterestRates .................................................................................................................. 45 2.4 Measuring Employment and Unemployment .. (47)Answering the Key Question ............................................................................................ 49 An Inside Look: Weak Construction Market Persists.......................................................... 50 Chapter 3 The Financial System 59 THE WONDERFUL WORLD OFCREDIT ................................................................................... 59 Key Issue and Question .................................................................................................... 59 3.1 Overview of the Financial System ...................................................................... 60 Financial Markets and Financial Intermediaries ................................................................ 61 Making the Connection: Is General Motors Making Cars or Making Loans .................... 62 Making the Connection: Investing in the Worldwide Stock Market . (64)Banking and Securitization (67)The Mortgage Market and the Subprime Lending Disaster (67)Asymmetric Information and Principal–Agent Problems in Financial Markets...................68 3.2 The Role of the Central Bank in the Financial System (69)Central Banks as Lenders of Last Resort ..........................................................................69 Bank Runs Contagion and Asset Deflation ....................................................................70 Making the Connection: Panics Then and Now: The Collapse of the Bank of United States in 1930 and the Collapse of Lehman Brothers in2008 (71)3.3 Determining Interest Rates: The Market for Loanable Funds and the Market forMoney .......................................................................................... 76 Saving and Supply in the Loanable Funds Market ........................................................... 76 Investment and the Demand for Loanable Funds ............................................................ 77 Explaining Movements in Saving Investment and the Real Interest Rate (78)CONTENTS .。
剖宫产术中娩出胎儿前膀胱下推法在凶险性前置胎盘手术中的应用效果孙美果;王艳玲;尹宗智;陈娅;杨媛媛【摘要】目的评价剖宫产手术时娩出胎儿前膀胱下推法在凶险性前置胎盘手术中的应用效果.方法选择2016年1月至2017年12月安徽医科大学第一附属医院产科收治凶险性前置胎盘孕产妇89例,根据剖宫产时下推膀胱的时机不同,分为A组(47例)与B组(42例),A组为娩出胎儿前膀胱下推组,B组为娩出胎儿后下推膀胱组.比较两组孕产妇一般情况(年龄、孕次、产次、孕周、胎盘植入率)、平均手术出血量、平均输血量、手术时间、术后住院时间、产褥病率、子宫切除、膀胱损伤和新生儿窒息方面的差异.结果 A、B组孕产妇术中出血量分别为(1927.76±356.31)mL、(2859.55±477.80)mL,输血量分别为(861.72±91.58)mL、(1285.73±162.69)mL,手术时间分别为(1.83±0.87)h、(2.71±0.94)h,术后住院时间分别为(5.37±1.72)d、(6.83±1.56)d,产褥病率分别为10.64%、28.57%,子宫切除率分别为14.89%、35.71%,新生儿窒息发生率分别为4.26%、19.05%,两组差异有统计学意义(P<0.05).结论凶险性前置胎盘娩出胎儿前膀胱下推法疗效满意,值得临床推广应用.【期刊名称】《安徽医学》【年(卷),期】2019(040)005【总页数】4页(P481-484)【关键词】凶险性前置胎盘;膀胱下推法;产后出血;子宫切除【作者】孙美果;王艳玲;尹宗智;陈娅;杨媛媛【作者单位】230022 合肥安徽医科大学第一附属医院妇产科;230022 合肥安徽医科大学第一附属医院妇产科;230022 合肥安徽医科大学第一附属医院妇产科;230022 合肥安徽医科大学第一附属医院妇产科;230022 合肥安徽医科大学第一附属医院妇产科【正文语种】中文凶险性前置胎盘是指孕妇既往有剖宫产史,本次妊娠为前置胎盘,且胎盘附着于瘢痕处,并常伴有胎盘植入,可导致难治性产后出血、休克和弥散性血管内凝血,增加母婴并发症,子宫切除率和孕产妇病死率均较高[1]。
医学英语收集诊断和治疗常用词汇inspection 望诊inquiry 问诊auscultation 听诊percussion 扣诊palpation 触诊biopsy 活组织检查pathological section 病理切片endoscopy 内窥镜检查ECG(electrocardiogram) examination 心电图检查EEG(electrocardiogram) examination 脑电图检查Intravenous pyelography 静脉肾盂造影术Skin-test 皮肤试验examination by centesis 穿刺检查routine analysis of blood 血常规分析urine analysis of blood 尿常规分析red blood cell count(RBC) 红细胞计数white blood cell count(WBC) 白细胞计数general check-up 全身检查routine examination 常规检查follow-up examination 随访检查consultation 会诊emergency 急诊diagnosis 诊断prognosis 预后convalescence, recovery 康复relapse 复发treatment 治疗prescribe 开药方fill a prescription 配药injecting 打针hypodermic injection 皮下注射intramuscular injection 肌肉注射intravenous injection 静脉注射inoculating 预防注射fluid infusion 点滴注射blood transfusion 输血dose 剂量tablet 药片capsule 胶囊liquid medicine 药水powder 药粉ointment 药膏(软膏)plaster 硬膏,石膏lotion 洗剂suppository 栓剂analgesics 止痛药antipyetics 退烧药antitussive 止咳药expectorant 祛痰药diuretics 利尿药hemostatic 止血药antidiarrheal 止泄药antipruritic 止痒药antidote 解毒药antirheumatic 抗风湿药anticarcinogen 抗癌药antibiotics 抗菌素anticoagulant 抗凝剂cardiac tonic 强心药vasodilator 血管舒张药vasoconstrictor 血管收缩药antiepileptic 抗癫痫药antispasmodic 解痉药sedative 镇静药anesthetics 麻醉药penicillin 盘尼西林streptomycin 链霉素gentamycin 庆大霉素aspirin 阿斯匹林morphine 吗啡dolantin 度冷丁iodine 碘酒distilled water 蒸馏水normal saline solution 生理食盐水atropine 阿托品hormone 激素glucose 葡萄糖side effect, adverse effect副作用operative treatment 手术疗法major operation 大手术minor operation 小手术anesthesia 麻醉general anesthesia 全身麻醉local anesthesia 局部麻醉excision, removal, resection切除术tonsillectomy 扁桃体切除术thyroidectomy 甲状腺切除术pneumonectomy 肺切除术mastectomy 乳房切除术gastrectomy 胃切除术cholecystectomy 胆囊切除术hepalobectomy 肝叶切除术splenectomy 脾切除术nephrectomy 肾切除术salpingectomy 输卵管切除术hysterectomy 子宫切除术hysteromyomectomy 子宫肌瘤切除术proctectomy 直肠切除术appendectomy 阑尾切除术prostatectomy 前列腺切除术tracheotomy 气管切开术incision of abscess 脓肿切开术craniotomy 颅骨切开thoracotomy 胸廓切开laparotomy 剖腹术amputation 截肢fixation 固定hot compress 热敷cold compress 冷敷gastric lavage 洗胃enema 灌肠urethral catheterication 导尿hemostasis 止血dressing 包扎sew up the incision 缝合切口remove the stitches 拆线cardiac massage 心脏按摩artificial respiration 人工呼吸diet 饮食special diet 特定饮食low protein diet 低蛋白饮食low fat diet 低脂肪饮食low calorie diet 低热量饮食liquid diet 流质饮食semi-liquid diet 半流质饮食solid diet 固体饮食light diet 易消化的饮食vegetable diet 素食中英文对照妇产科学词汇Aabactio 人工流产abactus venter 人工流产abdomen circumference腹围abdominal 腹部的abdominal cellotomy 腹式开腹术abdominal cesarean sect ion 腹式剖宫产abdominal delivery 剖宫产abdominal drainage 经腹引流abdominal hysterectomy腹式子宫切除术abdominal part 腹部abdominal pregnancy 腹腔妊娠abdominal pressure 腹压abdominal salpingectomy 腹式输卵管切除术,剖腹输卵管切除术abdominal salpingo-oophor ectomy 腹式输卵管卵巢切除术,剖腹输卵管卵巢切除术abdominal stalk 脐带,腹蒂abdominal tubal sterili zation 腹式输卵管绝育术abdominal version 外倒转术abdominopelvic cavity 盆腹腔abdominoscopy 腹腔镜检法abdominouterectomy 腹式子宫切除术,剖腹子宫切除术abdominouterotomy 腹式子宫切开术,剖腹子宫切开术aberratio mensium 月经迷乱,倒经aberratio menstruorum月经迷乱,倒经ability to conceive受孕能力ablatio placentae 胎盘早期剥离abnormal bleeding 异常出血abnormal labor 异常分娩abnormal pregnancy 异常妊娠abnormal uterine action 产力异常ABO blood group ABO血型ABO incompatibility ABO 血型不合,ABO不合aborticide 堕胎,堕胎药abortifacient agents 堕胎药abortion 流产abortion applicant 要求流产者abortion on demand 要求流产abortionist 堕胎者abortus 流产儿abruptio placenta 胎盘早期剥离abruption of normallyimplanted placenta 正常位置胎盘早期剥离abscess 脓肿abscess of Bartholingland 前庭大腺脓肿absence of uterus 无子宫absence of vagina 无阴道accessory placentae 副胎盘accessory placenta 副胎盘accidental abortion 意外流产accouchee 产妇accouchement 生产,分娩acquired dysmenorrhea继发性痛经acquired immune deficiency syndrome 获得性免疫缺陷综合征,爱滋病acromio-iliac presentation 肩髋先露,横产位active pill days 有效避孕期acute cervicitis 急性宫颈炎acute fatty liver ofpregnancy 妊娠急性脂肪肝acute pelvic inflammatory disease 急性盆腔炎acute salpingitis 急性输卵管炎acute salpingo-oophoritis急性输卵管卵巢炎acyesis 不孕,不育acyeterion 避孕药adenexa 附件adenomas endometrioidesovarii 卵巢子宫内膜异位adenomatous glandular hyperplasia of endometham 子宫内膜腺型增生过长adenomatous hyperplasia腺瘤型增生过长adenomyosis 子宫内膜异位症,子宫腺肌病,肌腺瘤adenomyosis externa 子宫外子宫内膜异位症adenomyosis interna 子宫内子宫内膜异位症adherent placenta 粘连性胎盘adhesion of cervicalcannel 宫颈粘合adhesion of IUD 宫内节育器粘连aditus ad pelvis 骨盆上口aditus pelvis 骨盆入口,骨盆口aditus vaginae 阴道口adnexa uteri 子宫附件adnexal disease 子宫附件疾病adnexectomy 子宫附件切除术,附件切除adnexitis 子宫附件炎,附件炎adosculation 体外受精afterpains 产后宫缩痛afterwaters 后羊水air embolism 空气栓塞algomenorrhea 痛经amenia 闭经,停经amenorrhea due to uterine lesion 子宫性闭经amnionic fliud embolism羊水栓塞ampullar lactiferae输乳管壶腹,输乳管瘘ampullary pregnancy 输卵管壶腹部妊娠amputation of cervix宫颈切除术anastomosis of tube输卵管吻合术anatomic internal os解剖学内口anatomy 解剖学angle of subpubic arch 耻骨弓角度ankylocolpos 阴道闭锁annexitis 子宫附件炎,附件炎anovaria 无卵巢anovular menstruation无排卵性月经,不排卵性月经anovulatory bleeding 无排卵性出血anovulatory dysfunctionaluterine bleeding 无排卵性功能失调性子宫出血anoxia neonatorum 新生儿缺氧anoxic ischemic encephalopathy 缺氧缺血性脑病anteflexion of uterus子宫前屈antenatal 产前的,出生前的antenatal care 产前保健,产前护理antenatal diagnosis 产前诊断antenatal genetic diagnosis 产前遗传诊断antepartum eclampsia 产前子痫antepartum fetal death产前胎儿死亡anterior colporrhaphy阴道前壁修补术anthropoid pelvis 类人猿型骨盆anti-sperm antibody 抗精子抗体anticonceptive 避孕药anticoncipiens 避孕药apoplexia uteroplacenta子宫胎盘卒中arrested labor 产程停滞art insem 人工受精arteria ovarica 卵巢动脉arteria urerina 子宫动脉arteria vaginalis 阴道动脉arteriae pudendae exter nae 阴部外动脉artificial abortion 人工流产artificial abortion-vacuu m aspiration 负压吸引人工流产术artificial vagina 人工阴道Asherman syndrome 子宫腔粘连综合征,阿谢曼综合征,阿氏综合征,宫腔粘连综合征asphyxia livida 青紫窒息asphyxia neonatorum 新生儿窒息asphyxia pallida 苍白窒息atresia hymenalis 处女膜闭锁atresia of cervix 子宫颈闭锁aresia of hymen 处女膜闭锁atresia of vagina 阴道闭锁atypical epithelium 不典型上皮atypical hyperplasia 不典型增生atypical hyperplasia of endometrium 子宫内膜不典型增生Bbarrenness 不孕症,不育症bartholinitis 前庭大腺炎basal body temperature 基础体温baseline heart rate胎心率基线badeline oscillation 基线摆动benign mole 良性葡萄胎benign trophoblastic di sease 良性滋养细胞疾病bilanual gynecological examination 妇科双合诊检查biparietal diameter 双顶径bispinous diameter 坐骨棘间径blennometritis 子宫内膜炎blood brain barrier血脑屏障blood group 血型bloody show 见红bony birth canal 骨产道bony pelvis 骨盆borderline ovarian tumors 卵巢交界性肿瘤botryoid sarcoma of uterus 子宫葡萄状肉瘤Bowen disease 鲍文病broad ligament 阔韧带bruit placentaire 胎盘杂音Ccancer in situ 原位癌carcinoma cervicis uteri 子宫颈癌carcinoma colli uteri子宫颈癌carcinoma in situ ofcervix 宫颈原位癌carcinoma in situ ofuterine cervix 宫颈原位癌carcinoma of ovary 卵巢癌carcinoma of vulva 外阴癌carcinoma ovarii 卵巢癌carcinoma tubae 输卵管癌carcinoma vulvae 外阴癌cardinal ligament 主韧带cavity of uterus 子宫腔celio-salpingo-oothecectomy腹式输卵管卵巢切除术central placenta previa中央前置胎盘,完全前置胎盘cephalotomy 穿颅术cephalotracter 产钳cervical adeno-squamouscarcinoma 宫颈腺-鳞癌cervical dilatation 宫颈扩张cervical dysplasia 宫颈非典型增生cervical ectropion 宫颈外翻cervical endometritis宫颈内膜炎cervical hypertrophy 宫颈肥大cervical laceration 宫颈裂伤cervical mucus 宫颈黏液cervical pregnancy 宫颈妊娠cervical squamous celldysplasia 宫颈鳞状上皮非典型增生cervlcal laccration 宫颈裂伤childbirth without pain无痛分娩chorioadenoma 绒毛膜腺癌,恶性葡萄胎choriocarcinoma 绒毛膜癌chorionic gonadotropinhormone 绒毛膜促性腺激素chronic pelvic inflammatory disease 慢性盆腔炎chronic pelvic parametritis 慢性盆腔结缔组织炎chronic salpingitis 慢性输卵管炎chronic salpingo-ocphoritis 慢性输卵管卵巢炎chronic vulvar dystrophy 慢性外阴营养不良claustrum virginale 处女膜colpoplasty 阴道成形术colpopoiesis 阴道成形术colporrhaphia anterior阴道前壁缝合术colporrhaphia anterior-posterior 阴道前后壁修补术colporrhaphia posterior阴道后壁修补术colposcope 阴道镜commissura labiorum posterior 阴唇后联合complete hysterectomy全子宫切除术complete placenta previa 中央前置胎盘,完全前置胎盘condom 阴茎套condyloma 湿疣condyloma acuminata 外阴尖锐湿疣congenital absence ofuterus 先天性无子宫congenital absence ofvagina 先天性无阴道,先天性阴道阙如congenitaladrenal cortical hyperplasia 先天性肾上腺皮质增生症conization of cervix宫颈锥切术conization of the cervix 宫颈锥形切除术conjugata diagonalis 对角径conjugata vera obstetrica 产科结合径,产科直径conjugata of inlet 入口前后径conjugata of outlet出口前后径conjugata vera 真结合径conservative myomectomy保守性肌瘤摘除术constriction rings 子宫痉挛性狭窄环contact bleeding 接触性出血contracted pelvic inlet骨盆入口狭窄contracted pelvic outlet 骨盆出口狭窄contraction stress test宫缩应激试验cord around neck 脐带绕颈cornual pregnancy 宫角妊娠,子宫角妊娠corona radiata 辐射冠,放射冠corpora atretica 闭锁卵泡corpora luteum gravidit atis 妊娠黄体,真黄体corpora pampiniforme 卵巢冠corporeal cesarean sect ion 古典式剖宫产术cortex of ovary 卵巢皮质crown-heel length 顶踵长,冠踵长,立高crowning of head 胎头着冠culdocentesis 后穹隆穿刺术curettage of the uter ine cavity 刮宫术cyesiognosis 妊娠诊断cysthitis 女阴炎cystic hyperplasia of endometrium 子宫内膜囊腺型增生过长cysto urethrocele 尿道膀胱膨出cystocele 膀胱膨出cystocele perinealis 会阴膀胱膨出cystocele vaginalis阴道膀胱膨出cystoma ovarii 卵巢囊肿cydtoma paraovarii 卵巢冠囊肿Ddecidua 蜕膜decidua basalis 底蜕膜,基蜕膜decidua capsularis 包蜕膜decidua interuteroplacent alis 底蜕膜,基蜕膜decidua parietalis 壁蜕膜decidua reaction 蜕膜反应decidua reflexa 包蜕膜decidua serotina 底蜕膜decidual cast 蜕膜管型deep lying placenta低置胎盘deep transverse arrest 持续性枕横位defloration 处女膜破裂delayed amniotic fluid embolism 迟发型羊水栓塞delivery before arrival 急产delivery date rule 分娩日期规律delivery mechanism 分娩机制delivery room 分娩室,产房denticular hymen 锯齿状处女膜descensus uteri 子宫脱垂descensus vaginae anterior 阴道前壁脱垂descent vaginae posterior 阴道后壁脱垂diabetic vulvitis 糖尿病性外阴炎diagnostic curettage 诊断性刮宫diagnostic fractional curettage 诊断性分段刮宫diagnostic puncture 诊断性穿刺diagonal 对角线,斜的diaphragma pelvis 盆膈diaphragma urogenitale尿生殖膈diastematelytria 阴道纵裂diastematometria 子宫纵裂difficult delivery 难产difficult labour 难产dilatation of uterinecervix 宫颈扩张术disseminated intravascular coagulation 播散性血管内凝血,弥散性血管内凝血dysfunctional uterine bleeding 功能失调性子宫出血Eearly deceleration 早期减速early delivery 早产early invasive carcinoma 早期浸润癌eccyesis 异位妊娠,子宫外孕eclampsia 子痫eclampsia intrapartum产时子痫,产间子痫eclampsia puerperalis产惊,产后子痫eclamptic coma 子痫昏迷ectopia of IUD 宫内节育器异位ectopic fetation 异位妊娠ectopic gestation 异位妊娠electrocauterization ofcervix 宫颈电烙术emmenia 月经endocervical scraping smear 宫颈管刮片endometiosis externa 外在性子宫内膜异位症endometrial carcinoma of uterus 子宫内膜癌endometrial tuberculosis子宫内膜结核endometrorrhagia 子宫出血,血崩episiohematoma 外阴血肿episioitis 外阴炎epithelial tumor of ovary 卵巢上皮性肿瘤excision of Bartholingland cyst 前庭大腺囊肿切除术excision of cervicalpolyp 宫颈息肉摘除术excision of cervicalstump 宫颈残端切除术excision of imperforatehymen 无孔性处女膜切开术expulsion of IUD 宫内节育器脱落extended hysterectomy次广泛子宫全切除术extraperitoneal cesareansection 腹膜外剖宫产术Ffallectomy 输卵管切除术falling of womb 子宫脱垂fetal heart rate 胎心率fetal heart rate-baseline 胎心率基线fetal heart rate-baseline variability 胎心率基线变异fetal heart rate monitoring 胎心率监测fetal heart sound 胎心音,胎儿心音fetal lung maturity胎儿肺成熟度fetal macrosomia 巨大胎儿fetal position 胎方位,胎位fetal posture 胎势fetal presentation 胎先露foetal membranes 胎膜foetus papyraceus 纸样胎儿,压扁胎forceps delivery 产钳分娩fractional curettage ofuterus 分段刮宫术frenulum clitoridis 阴蒂系带frenulum labiorum pudendi 阴唇系带frenulum of clitoris阴蒂系带fronto-anterior position额前位fronto-dextra anterior右额前位fronto-dextra posterior右额后位fronto-dextra transverse右额横位fronto-laeva anterior左额前位fronto-laeva posterior左额后位fronto-lavea transverse左额横位fronto-occipital diameter枕额径,前后径fronto-posterior position额后位fronto-transverse position 额横位frontomental diameter枕颏径frozen pelvis 冰冻骨盆full-term birth 足月产full-term living birth 足月活婴full-term normal delive ry 足月顺产full-term normal vagina l delivery 足月正常阴道分娩fundus of uterus 子宫底Ggalactorrhea-amenorrhea s yndrome 乳泌-闭经综合征galea forceps 头皮钳gestational diabetes me llitus 妊娠糖尿病granulosa theca cell tumor 颗粒-卵泡膜细胞瘤gravida 产妇graviditas fimbriae tub arica 输卵管伞graviditas tubaria 输卵管妊娠graviditas tubaria ampu llaris 输卵管壶部妊娠graviditas tubaria infu ndibularis 输卵管漏斗部妊娠graviditas tubaria inte rstitialis 输卵管间质部妊娠graviditas tubaria isth mica 输卵管峡部妊娠graviditas tuboabdominali s 输卵管腹腔妊娠graviditas tuboovarialis 输卵管卵巢妊娠greater lip of pudend um 大阴唇greater pelvis 大骨盆greater vestibular glan d 前庭大腺greater length 最大长度,最大身长Hhabitual abortion 习惯性流产haemophilis vaginitis嗜血杆菌阴道炎haemorrhagia ovulations 排卵出血head locking 胎头交锁height-weight-age table 身高体重年龄对照表heterotopic endometriosis 子宫内膜异位症hiphasic basal body t emperature 双相基础体温Hunter ligament 亨特韧带,子宫圆韧带hydatid pregnancy 葡萄胎妊娠hydatidenmole 葡萄胎,水泡状胎块hydatidiform mole 葡萄胎hydrocephalus 脑积水,水脑hydrosalpinx 输卵管积水hymen 处女膜hymen cribriformis 筛状处女膜hymen falciformia 镰状处女膜hymen fimbriatus 伞状处女膜hymen imperforatus 无孔处女膜,处女膜闭锁hymenalatresic 处女膜闭锁hyperprolactinaemic amenorrhoea 高生乳素血症性闭经,高泌乳素血症性闭经hypertension syndrome of pregnancy 妊娠高血压综合征hyperthyroidism 甲状腺功能亢进hypofunction of corpusluteum 黄体功能不足hypoplasia of the uterus 子宫发育不全hypothalamic-pituitary-ovarian axis 下丘脑-垂体-卵巢轴Iinclination of pelvis骨盆倾斜度Llaparotrachelotomy 子宫颈切开剖宫产术,子宫下段剖宫产术last menstrual period末次月经left fronto-anterior 左额前位left fronto-posterior左额后位left fronto-transverse左额横位left mentoanterior 左颏前位left mentotransverse 左颏横位left mintoposterior 左颏后位left occipitoanterior左枕前位left occipitoposterior左枕后位left occipitotransverse左枕横位left sacroanterior 左骶前位left sacroposterior 左骶后位left sacrotransverse 左骶横位left scapuloanterior 左肩前位left scapuloposterior左肩后位leiomyoma-uteri 子宫平滑肌瘤lochia alba 白色恶露lochia cruenta 红色恶露lochia rubra 血性恶露lochia serosa 浆液恶露low cesarean section子宫下段剖宫产Mmalignant hydatidiformmole 恶性葡萄胎Manchester operation 曼澈斯特手术maternal mortality rate孕产妇死亡率,母体死亡率mediolateral episiotomy会阴正中旁切开,会阴侧切术membrana agnina 羊膜membrana caduca 蜕膜metastatic carcinoma ofovary 卵巢转移性癌metastatic choriocarcinoma 转移性绒毛膜癌metroscopy 子宫镜检查,宫腔镜检查missed abortion 稽留流产myoma of the uterus子宫肌瘤myoma of uterus 子宫肌瘤myoma submucosum 黏膜下肌瘤myoma subserosum 浆膜下肌瘤myoma uteri 子宫肌瘤myomectomy 子宫肌瘤切除术,肌瘤挖出术myxoma peritonei 腹膜黏液瘤NNaboth cyst 子宫颈腺囊肿,纳博特囊肿,纳氏囊natural labor 顺产,自然分娩Oobstetric forceps delivery 产钳术obstetrician 产科医师obstetrician-gynaecologist妇产科医师old primipara 高年初产妇oophoritic cysts 卵巢囊肿oothecocyesis 卵巢妊娠oothecoma 卵巢瘤oothecorrhexis 卵巢破裂ovariam-ascites-pleural effusion syndrome 卵巢-腹水-胸水综合征,麦格斯综合征ovarian amenorrhea 卵巢性闭经ovarian ligament 卵巢固有韧带ovariosalpingectomy 卵巢输卵管切除术,输卵管卵巢切除术ovarium 卵巢ovulatory dysfunctionaluterine bleeding 排卵功能失调性子宫出血oxytocin challenge test催产素激惹试验Ppainless delivery 无痛分娩painless labor 无痛分娩partus immaturus 早产partus maturus 足月产partus precipitatus 急产partus serotinus 过期产pelvic axis 骨盆轴pelvic cavity 骨盆腔pelvic congestion syndr ome 盆腔淤血综合征pelvic diaphragm 盆膈pelvic inlet plane 入口平面pelvic midplane 中骨盆平面pelvic outlet plane出口平面pelvimeter 骨盆测量器perimenopausal syndrome 围绝经期综合征,更年期综合征perineal laceration1°会阴1°撕裂perineal laceration2°会阴2°撕裂perineal laceration3°会阴3°撕裂perineal lateralis 会阴侧切开术periodoscope 分娩日期计算表peritoneal dropsy 腹水physiologic retraction ring 生理性缩复环placenta accreta 侵入性胎盘,植入性胎盘plural pregnancy 多胎妊娠post term infant 过期产儿postmenopausal bleeding 绝经后出血,绝经后流血postmenopausal genital hemorrhage 绝经后生殖道出血postmenopausal osteoporos is 绝经后骨质疏松postpartum hemorrhage产后出血pregnancy with IUD in situ 带器妊娠proper ligament 卵巢固有韧带protracted active phase dilatation 活跃期宫口扩张停滞puncture of posterior fornix of vagina 阴道后穹隆穿刺pyometra 宫腔积脓pyometritis 化脓性子宫炎pyometrium 子宫积脓Rrepair of old perinea l laceration 陈旧性会阴裂伤修补术retention of menses经血潴留rupture of tubal pregnancy 输卵管妊娠破裂Ssafe period contraception 安全期避孕sarcoma botryoides 葡萄状肉瘤,葡萄样肉瘤Ttocomonitor 分娩监护仪trichomonous vaginitis滴虫性阴道炎Uuterine sarcoma 子宫肉瘤uterine serosa 子宫浆膜Vvaginal cuff 阴道断端vaginal hysterectomy 阴道式子宫切除术,阴道子宫切除术vaginal secretion 阴道分泌物vaginal smear 阴道涂片vaginitishemoptulus vaginalis 阴道嗜血杆菌性阴道炎velamentous insertion帆状附着,脐带帆状附着velamentous placenta 帆状胎盘venae ovarica dextra右卵巢静脉venae ovarica sinistra 右卵巢静脉vesico-uterine fistula膀胱子宫瘘vesico-vaginal fistula膀胱阴道瘘vesicocervical fistula膀胱子宫颈瘘vesicular mole 水泡状胎块,葡萄胎vulneratio hymenalis 处女膜损伤vulva condyloma acuminata 外阴尖锐湿疣vulval basal cell carcinoma 女阴基底细胞癌vulval Bowen disease女阴原位癌vulvopathy 外阴病阿普加评分 Apgar score癌性腹膜炎 cancerous peritonitis,carcinomatous peritonitis,peritonitis carcinomatosa癌转移 cancerometastasis爱滋病病毒 human immunodeficiency virus按期服用避孕丸 sequential pills按期口服避孕丸 sequentials巴氏腺 Bartholin gland白斑 leukoplakia,leukasmus,tacheblanche白斑病 leukopathia,leucoderma白斑病外阴炎 leukoplakic vulvitis白斑病性角化不良 leukoplakic dyskeratosis白带 leulomatorrhea vaginalis,leukorrhea,fluor albus,leukomatorrhea vaginalis,profluvium muliebre,whites白色恶露 lochia alba,alba lochia白色念珠菌 Saccharomyces albicans,candida albicans白色念珠菌性阴道炎 Candida albicans vaginitis包蜕膜 decidua capsularis,decidua reflexa,capsular deciduas保守性肌瘤摘除术 conservative myomectomy鲍文病 Bowen disease暴发子痫 fulminant eclampsia闭经 suppression of menses,suppressed menstruation,amenia ,amenorrhea闭经的 amenorrheal,amenerrheic,amenorrheic壁内的 intramural壁内肌瘤 intraparietal myoma壁内平滑肌瘤 intramural leiomyoma壁蜕膜 decidua parietalis,decidua vera避孕药 anticoncipiens,anticonceptive,acyeterion,contraceptive agents避孕药膜 contraceptive film边缘性前置胎盘 placenta praevia marginalis扁平骨盆 platypelloid pelvis,Deventer diameter pelvis,flat pelvis,pelvis plana扁平骨盆 flat pelvis,flattened pelvis扁平湿疣 condyloma lata 变异减速 variable deceleratio n变异型心率减慢 variable deceleratio ns表皮 epiderm表皮癌 epidermal carcin oma表皮样畸胎瘤 epidermoid teratom a表皮样微小癌 epidermoid microcarc inoma表皮样原位癌 epidermoid carcinoma in situ表皮增殖如疣 epidermoma冰冻骨盆 frozen pelvis 并发先兆子痫 superimposed preecla mpsia并合肌瘤 synaetosis并脑独眼畸胎 cyclocephalus并脑畸形 cyclencephalus并胚 duplicitas,duplicity 并躯联胎 syssomus并头联胎 symphyocephalus,syncephalus,synencephalus,sycephalus,deradelphus,duplicitas cruciata并腿畸形 sireniform fetus,symphysoskelia,symmelus,symmelia并眼畸形 symphysopsia,synopsia,synophthalmia,synophthalmus,synopsy,anophthalmus cyclopica,fused eyeball并指/趾 dactylium,dactylosymphysis并指/趾缺指/趾畸形 ectrosyndactylia并指/趾者 syndactylus并指并趾畸形 syndactyly并指畸形 symphysodactylia,aschistodactylia病毒学 Virology病毒诱发的肿瘤 virus induced tumo r病理缩复环 pathologic retractio n ring不典型增生 atypical hyperplasia 不全中隔子宫 uterus subseptus不完全流产 incomplete abortion 不完全破裂 incomplete rupture不协调性子宫收缩 incoordinated uterine action不锈钢麻花环宫内节育器 stainless steel“ma-hua”ring IUD不锈钢圆环宫内节育器 stainless steel ring IUD不孕症 barrenness,infertility部分性葡萄胎 partial hydatid mole部分性前置胎盘 partial placenta praevia,placenta praevia partialis,incomplete placenta previa部分子宫切除术 partial hysteretomy残端妊娠 stump pregnancy残角妊娠 pregnancy in rudimentary born残角子宫 rudimentary horn of uterus残留卵巢综合征 residual ovary syndrome产程停滞 arrested labor产程图 partogram产道裂伤 laceration of birth canal产妇 parturient,puerpera,puerperant,accouchee,lying-in woman产后出血 postpartum hemorrhage产后宫缩痛 afterpains产后静脉炎 puerperal phlebitis产后血栓形成 puerperal thrombosis产后子宫内膜炎 puerperal endometritis产后子宫炎 lochiometritis产后子痫 eclampsia postpartum,eclampsia puerperalis产间子痫 eclampsia intrapartum产科出血 obstetric hemorrhage产科医师 obsterist,obstetrician,accoucheur产科医师助理 obstetrical physician assistant产力异常 abnormal uterine action产前保健 prenatal care,antenatal care产前估计胎儿成熟度 prenatal estimationof fetal maturity产前遗传诊断 antenatal geneticdiagnosis产前子痫 antepartum eclampsia产钳分娩 forceps delivery产钳术 obstetric forcepsdelivery,instrumental extraction产褥感染 puerperal infection,infection puerperalis产褥股白肿 phlegmasia alba dolens puerperarum产褥期 puerperium,puerperal state,ramus pubicus arteriaeepigapuerperal state,lying-in,stegmonth产褥期精神病 puerperal psychosis产伤 birth trauma,birth injury,birth injuries陈旧性会阴裂伤修补术 repair of old perineal laceration成熟卵泡 Graafian follicle持续性枕横位 persistent occipitotransverse position,deep transverse arrest,transverse arrest持续性枕后位 persistent occipitoposterior position,persistant posterior occipit position耻骨弓 pubic arch耻骨弓角度 angle of subpubicarch,subpubic angle出口产钳 outlet forceps出口横径 transverse outlet出口后矢状径 posterior sagittaldiameter of outlet,posterior sagittal diameter,posterior sagittal ofoutlet出口平面 pelvic outlet plane出口前后径 the anterior-posterior outlet diameter,conjugate of outlet出生缺陷 birth defect,birth defects出血点 petechia初产妇 unipara,primipara 初潮 first menstruation 初次妊娠的 primigravid初级卵母细胞 primary oocyte,first oocyte初级卵泡 primary follicle,folliculi ovarici prima rii,folliculi oophori prima rii初乳 colostrum,breastings,neogala,fore milk处女膜闭锁 atresia of hymen,imperforate hymen,atresia hymenalis,unperforated hymen,hymen imperforatus,hymen occlutus,hymenalatresic处女膜裂伤 leceration of thehymen处女膜破裂 defloration处女膜破损 ruptured hymen处女膜切除 hymenectomy处女膜损伤 vulneratio hymenalis 处女膜完整 hymen intactus,intact hymen穿颅术 craniotomy,cephalotomy,eccephalosis,transforation垂体功能减退症 hypopituitarism雌激素撤退性出血 estrogen withdrawalbleeding雌激素试验 estrogen test雌激素替代疗法 estrogen replacement therapy雌激素与肌酐比值 estrogen/creatinine ratio,estrogen to creatinineratio次广泛子宫全切除术 extended hysterectom y单纯外阴切除术 simple vulvectomy低位产钳术 low forceps delive ry滴虫病 trichomoniasis滴虫性阴道炎 trichomonous vaginit is,Trichomonas vaginitis,colpitis trichomonadis滴虫阴道炎 trichomonal vaginitis底蜕膜 decidua basalis,decidua serotina,decidua interuteroplacentalis第二产程 second stage oflabor第三产程 third stage of labor,placental stage,opsitocia第一产程 first stage of labor堕胎 abort,feticide,foeticide,aborticide堕胎药 abortive,abortifacient,ambiotic remedy,abortifacient agents,abortient,abortigenic,aborticide恶露 lochia,lyma恶性子宫绒毛膜上皮癌 malignant uteri chorion-epithelioma负压吸引人工流产术 artificial abortionvacuum aspiration附件切除术 ecphyadectomy,annexectomy腹膜外剖宫产术 extraperitoneal cesarean section,Latzko cesarean section腹膜外引流 extraperitoneal drainage腹膜外子宫切除术 extraperitoneal hysterectomy腹腔积血 hematocelia,hemoperitoneum,hematocoelia腹式输卵管绝育术 abdominal tubal sterilization腹式输卵管卵巢切除术 abdominal salpingo-oophorectomy,celio-salpingo-oothecectomy腹式输卵管切除术 abdominal salpingectomy,celiosalpingectomy腹式子宫卵巢输卵管切除术 celiohysterosalpingo-oothecectomy感染性休克 septic shock高龄初产妇 elderly primipara高泌乳素血症性闭经 hyperprolactinaemicamenorrhoea高张性子宫乏力 hypertonic uterineinertia更年期 climacteric period,climacterium,climacter,perimenopausal period,perimenopause,age critique,climacteric,involution period功能失调性子宫出血 dysfunctional uterine bleeding宫颈 cervix,cervix uteri宫颈癌 carcinoma of uterine cervix,cancer of cervix宫颈电烙术 electrocauterizationof cervix宫颈电灼术 cauterization of cervix宫颈刮片 cervical scrapingsmear宫颈管刮片 endocervical scraping smear宫颈非典型增生 cervical dysplasia宫颈浸润癌 invasive carcinomaof cervix宫颈鳞型细胞癌 squamous cell carcinoma of cervix宫颈鳞状上皮非典型增生 cervical squamouscell dysplasia宫颈黏液检查 cervical mucus examination宫颈锥切术 conization of cervix宫内发育迟缓 intrauterine growthretardation宫内感染 intrauterine infection宫内节育器 intrauterine device,intrauterine contraceptive device宫内节育器排出 intrauterine deviceexpulsion宫内节育器嵌顿 incarceration of IUD宫内节育器脱落 expulsion of IUD宫内节育器移位 displacement of IUD宫内节育器异位 ectopia of IUD宫内节育器粘连 adhesion of IUD宫内节育器子宫完全性穿孔 complete perforation of uterus by宫腔镜 hysteroscope,uteroscope宫腔镜检查 hysteroscopy,uteroscopy宫缩乏力 uterine inertia宫缩应激试验 contraction stress test古典式剖宫产术 classical cesarean section,corporeal cesarean sect ion骨盆漏斗韧带 ligament infundibulu m pelvicun,infundibulopelvic ligamen t,ligamenta infundibulo-pel vinum骨盆入口狭窄 contracted pelvic inlet骨盆外测量 external pelvimetry 刮宫术 dilatation and cur ettage,curettage of the uter ine cavity,intrauterine curettage过期产儿 post term infant 过期妊娠 prolonged pregnancy,postterm pregnancy红色恶露 rubra lochia,lochia cruenta后穹隆 posterior fornix 后穹隆穿刺术 puncture of poster ior fornix后穹隆切开术 posterior colpotomy 壶腹部妊娠 graviditas ampullari s黄体功能不足 inadepuate luteal function会阴1°撕裂 perineal lacerat ion1°会阴2°撕裂 perineal lacerat ion2°会阴3°撕裂 perineal lacerat ion3°会阴侧切术 lateral episiotomy 基线摆动 baseline oscillation 计划分娩 programed delivery 计划生育 planned childbirth,planning parenthood,family planning经闭-乳溢综合征 amenorrhea-galactorrhea syndrome痉挛性痛经 spasmodic dysmenorrhea痉挛性狭窄环 constriction ring扩张宫颈和刮宫术 dilation and curettage,dilatation and curettage扩张宫颈和清宫术 dilatation andevacuation卵巢浆液乳头状癌 sero-papillary cancer of the ovary卵巢浆液性囊腺瘤 ovarian serous cystadenoma,serous cystadenoma ofovary卵巢交界性肿瘤 borderline ovariantumors卵巢颗粒泡膜细胞瘤 granulose theca cell tumor of ovary卵巢颗粒细胞瘤 granulose cell tumor of ovary卵巢克鲁肯伯格瘤 Krukenberg tumor of ovary卵巢破裂 oothecorrhexis,ovariorrhexis卵巢巧克力囊肿 chocolate cyst ofovary难免流产 inevitable abortion,imminent abortion女性生殖系统 female reproductivesystem女性外生殖器官 demale external genital organs排卵 ovulation,ovulatio排卵期月经 kleine regel排卵功能失调性子宫出血 ovulatory dysfunctional uterine bleeding前庭大腺囊肿 Bartholin cyst前庭大腺脓肿 abscess of Bartholin gland,Bartholin gland abscess全子宫切除术 panhysterectomy,complete hysterectomy全子宫输卵管卵巢切除术 panhysteros-alpingo-oophorectomy全子宫输卵管切除术 panhysteros-alpingectomy人工阴道成形术 Baldwin operation妊娠高血压综合征 pregnancy inducedhypertension syndrome,hypertension syndrome of pregnancy,edema-proteinuria-hypertension syndrome生殖器脱垂 edeoptosis输卵管积脓 pyosalpinx输卵管间质部妊娠 interstitial tubalpregnancy,graviditas tubaria interstitialis,interstitial pregnancy,salpingysterocyesis输卵管流产 tubal abortion输卵管卵巢脓肿 tubo-ovarian abscess输卵管切除术 salpingectomy,tubal resection,fallectomy,fallotoimy输卵管妊娠破裂 rupture of tubalpregnancy,tubal rupture双相基础体温 biphasic basal body temperature,hiphasic basal body temperature胎盘早期剥离 premature separationof placenta,premature separation ofnormally implanted placenta胎盘滞留 placental retention,retentio placentae,retained placenta,retention of placenta头颅血肿 cephalohematoma,cephalhematoma头盆不称 cephalopelvic disproportion外阴尖锐湿疣condyloma acuminata外阴阴道炎 vulvovaginitis完全性前置胎盘 total placenta praevia,placenta praevia tolalis无脑儿 anencephaly,anencephalus无排卵性功能失调性子宫出血 anovulatory dysfunctional uterine bleeding无痛分娩 painless labor,。
热点练01 阅读理解之应用文距离高考还有一段时间,不少有经验的老师都会提醒考生,愈是临近高考,能否咬紧牙关、学会自我调节,态度是否主动积极,安排是否科学合理,能不能保持良好的心态、以饱满的情绪迎接挑战,其效果往往大不一样。
以下是本人从事10多年教学经验总结出的以下学习资料,希望可以帮助大家提高答题的正确率,希望对你有所帮助,有志者事竟成!养成良好的答题习惯,是决定高考英语成败的决定性因素之一。
做题前,要认真阅读题目要求、题干和选项,并对答案内容作出合理预测;答题时,切忌跟着感觉走,最好按照题目序号来做,不会的或存在疑问的,要做好标记,要善于发现,找到题目的题眼所在,规范答题,书写工整;答题完毕时,要认真检查,查漏补缺,纠正错误。
总之,在最后的复习阶段,学生们不要加大练习量。
在这个时候,学生要尽快找到适合自己的答题方式,最重要的是以平常心去面对考试。
英语最后的复习要树立信心,考试的时候遇到难题要想“别人也难”,遇到容易的则要想“细心审题”。
越到最后,考生越要回归基础,单词最好再梳理一遍,这样有利于提高阅读理解的效率。
另附高考复习方法和考前30天冲刺复习方法。
现在是信息爆炸时代,报纸、电视、互连网等媒体上的广告铺天盖地,我们在日常生活中随处可以见到形形色色的广告。
我们面临升学、就业、旅游、购房等问题时都会想到广告,希望能从各种广告中获取有用信息,实现我们的愿望,解决实际的生活、工作等问题。
因此,高考命题人十分注重考查考生对广告等应用文体的阅读能力,这也是一种运用所学语言知识解决实际问题的能力。
1. 先看问题,再读文章做阅读理解是先看问题,还是先看文章,这是很多同学经常问的问题。
我觉得这两种方法各有利弊,应视具体情况而定。
就阅读广告而言,还是先看问题比较好,因为广告类的试题绝大部分是寻找信息的题目,大可不必从头读到尾,带着问题有针对性地去跳读、略读,这样就可以节约不少时间。
2. 抓住广告的标题如果广告有标题,大标题下又有小标题,那么,快速寻找原文信息时,这些标题就成了很重要的线索,可以帮助我们快速准确地找到答案。
雅典行政管理学校—Cma Centre For Management And Ad 雅典行政管理学校—Cma Centre For Management And Ad 学校建于1978年,为学生提供的课程可以获得英国院校的颁发的学历证书或职业资格。
从学校建校以来,已经成功培养了数以千计的学生,有希腊本地的学生也有许多国际学生。
与英国的格拉摩根大学有着十三年的良好合作关系,为学生授予英国的高等教育课程,包括学士及硕士学位。
从毕业生的反应中得知,其中许多人已经开展更深一步的学习与研究,或者在希腊或其他国家获得了不错的职位。
该校不单单为学生提供完成希腊的学业的时机,而且还可以为学生在学习的任何一个阶段把现有的学分转到英国的学校继续学习课程设置学士学位课程bsc (hons) in business studieswith specialisation in:·management 管理·aounting & finance 会计和金融·marketing 营销·tourism 旅游硕士学位课程master in business administration (full/part time)·management 管理·aounting & finance 会计和金融·marketing 营销diploma in business studies(duration 2 years) 费用学士学位:约人民币48000元/年;注册费:约人民币3500元学校特色cma由英国威尔士大学授予许可的课程有:1.mba课程(全日制),研究专攻:管理、会计、金融、营销2.学士学位课程:商业(三年制)3.商业专业证书(两年制),研究专攻:管理、会计、金融、信息科技、运输-休闲-旅游。
生化汤加减合甲氨喋啶治疗异位妊娠(宁德市霞浦县中医院福建宁德352000)【摘要】目的:观察为异位妊娠病患应用生化汤加减合甲氨喋呤治疗的效果。
方法:将2008年3月-2011年11月的异位妊娠病患(41例)分组,中西联合组29例,口服生化汤加减(服用7日),同时注射甲氨喋呤(单次剂量),用量为每平方米50mg,最大剂量不超过50mg;甲氨喋呤组12例,注射甲氨喋呤(单次剂量),用量为每平方米50mg,最大剂量不超过50mg,观测包块大小和β-hcg血清水平。
结果:中西联合组β-hcg血清水平恢复的平均用时小于甲氨喋呤组,(p<0.05)用时差异明显;中西联合组的痊愈百分比为82.8%(24例),大于甲氨喋呤组(58.3%),(p<0.05) 痊愈百分比差异明显;中西联合组较甲氨喋呤组产生的不良反应少,(p<0.05) 不良反应差异明显。
结论:为异位妊娠病患应用生化汤加减合甲氨喋呤进行治疗时起效迅速,用药安全,为保守治疗中的高效方法。
【关键词】异位妊娠;甲氨喋呤;生化汤【中图分类号】r741.4 【文献标识码】b【文章编号】1004-5511(2012)04-0047-01 异位妊娠属于常见妇科疾病的一种,为急腹症,多数病患出现输卵管妊娠。
发病病患的增多使临床治疗受到更多的重视,若在早期确诊即可进行保守治疗,减少治疗风险,利于痊愈。
本文中将2008年3月-2011年11月的异位妊娠病患(41例)分组,其中一组应用生化汤加减合甲氨喋呤治疗,疗效满意,现报道结果如下。
1 资料与方法1.1 临床资料: 2008年3月-2011年11月的异位妊娠病患41例,b超确诊,均未破裂,未有年龄超过40岁的病患,均不低于22岁,均值(28.6±6.5)岁。
病患血压及呼吸状况平稳,β-hcg血清水平在3000iu/l以下。
37例曾经停经,时间范围为32-60天,其中出现不规则流血现象的病患有22例,时间范围为2-34天,均值(11.2±7.1)天。
可编辑修改精选全文完整版绪论单元测试1【判断题】 (2分)英语学科教学论,是介绍英语知识的一门课。
A.对B.错2【判断题】 (2分)英语学科教学论,是一门介绍如何教英语的课。
A.对B.错3【判断题】 (2分)关于教英语,需要了解相关的语言和语言学习的理论。
A.错B.对4【判断题】 (2分)关于教英语,还需要了解相关的教学方法、了解课堂管理的内容、学习教学设计的理念等。
A.错B.对5【判断题】 (2分)听说读写看的教学,是关于语言技能的教学。
A.错B.对第一章测试1【单选题】 (2分)Which is not the view of language? ( )A.Interactional ViewB.Structural ViewC.Functional ViewD.Constructive View2【单选题】 (2分)Which is not the view of language Learning? ( )A.Behaviorist TheoryB.Cognitive TheoryC.Schema TheoryD.Socio-constructive Theory3【单选题】 (2分)Which is from social-constructivist theory?A.stimulusB.ZPDC.reinforcementD.automatic response4【多选题】 (2分)For new language learning, the aspects that students need to do with are ( )A.Understand the formB.Understand the meaningC.Go abroad for studyingD.Practice the language5【多选题】 (2分)Which belong to process-oriented theory? ( )A.Socio-constructivist TheoryB.Schema TheoryC.Behaviorist TheoryD.Cognitive Theory6【多选题】 (2分)Which belong to condition-oriented theory? ( )A.Constructivist TheoryB.Behaviorist TheoryC.Socio-constructivist TheoryD.Cognitive Theory7【判断题】 (2分)The structural view of language is that language is a system of structurally related ele ments for the transmission of meaning. ()A.错B.对8【判断题】 (2分)The functional view only sees language as a means for doing things. ( )A.对B.错9【判断题】 (2分)For behaviorist theory, mistakes should be immediately corrected, and the correction s hould be immediately praised. ( )A.对B.错10【判断题】 (2分)Learning should be achieved via the dynamic interaction between the teacher and th e learner and between learners. ( )A.错B.对第三章测试1【判断题】 (2分)Teacher Talk Time means teacher should talk more in class and do not leave silence g ap in class. ( )A.对B.错2【判断题】 (2分)Remembering and understanding belong to the higher order thinking ability. ( )A.对B.错3【单选题】 (2分)Which one does not belong to the Bloom’s Taxonomy (2001)? ( )A.ApplyingB.AnalyzingC.RememberingD.Summarizing4【单选题】 (2分)For cognitive level of evaluating, the teacher may ask students the question like ( ).A.What is the relationship between A and B?B.How would you use this?C.Which is more interesting?D.What is the main idea of this paragraph?5【单选题】 (2分)For cognitive level of analyzing, the teacher may ask students the question like ( ).A.Which is more interesting, A or B?B.Can you compare A and B?C.Is there a better solution to this?D.What is an alternative method for this?6【多选题】 (2分)Which belong to teacher’s role? ( )A.controllerB.assessorC.prompterD.organizer7【多选题】 (2分)Teachers as facilitators means ( ).A.to guide them in planning and assessing their own learningB.to use various strategies to motivate learnersC.to develop their learning strategiesD.to create a positive learning environment8【多选题】 (2分)What are the two things that the teacher does as an assessor? ( )A.organizing feedbackB.controlling the paceC.correcting mistakesD.making research on student’s performance9【判断题】 (2分)Even the clearest instructions can be hard to grasp so, after you've given them, it's wo rth checking that they have been understood. ( )A.对B.错10【判断题】 (2分)Allow learners in class the time and the quiet they need, because they need time to thi nk, to prepare what they are going to say and how they are going to say it. ( )A.对B.错第四章测试1【单选题】 (2分)For WHERETO teaching design principle, W refers to ( ).A.allow students to evaluate their work and its implication’sB.be tailored (personalized) to the different needs, interests, and abilities of learnersC.equip students, help them experience the key ideas and explore the issuesD.help the students know where the unit is going and what is expected2【单选题】 (2分)For WHERETO teaching design principle, R refers to ( ).A.help the students know where the unit is going and what is expectedB.allow students to evaluate their work and its implication’sC.equip students, help them experience the key ideas and explore the issuesD.provide opportunities to rethink and revise their understandings and work3【单选题】 (2分)Which belongs to teaching design principle? ( )A.WHERETOB.ESAC.SMARTD.ABCD4【多选题】 (2分)What does WHERETO teaching design principle refer? ( )A.equip students, help them experience the key ideas and explore the issuesB.help the students know where the unit is going and what is expectedC.allow students to evaluate their work and its implication’sD.hook all students and hold their interest5【多选题】 (2分)What are the frequently applied teaching models? ( )A.WHERETO ModelB.Backward Design ModelC.ASSURE ModelD.ADDIE Model6【多选题】 (2分)What are the four elements of articulating learning objectives? ( )A.ConditionB.AudienceC.DegreeD.Behavior7【判断题】 (2分)Develop student’s reading skills. This learning objective is appropriately presented. ( )A.错B.8【判断题】 (2分)SMART is the method for articulating learning objectives. ( )A.对B.错9【判断题】 (2分)Activation of prior knowledge means activating cognitive structures that relate to the to pics and tasks to be studied and completed. ( )A.错B.对10【判断题】 (2分)The purpose of teaching design is to implement teaching effectively. ( )A.B.对第五章测试1【单选题】 (2分)What is used to express meanings in many subtle ways such as surprise, complaint, s arcasm, delighted, threats, etc.? ( )A.PronunciationB.morphologyC.PhonologyD.Intonation2【单选题】 (2分)What is the best age to start learning to read through phonics? ( )A.4-6B.C.1-2D.2-33【单选题】 (2分)After learning the individual letters’ sounds, it is natural to learn the sounds o f ? ( )A.consonant lettersB.blending lettersC.all of the aboveD.vowel letters4【多选题】 (2分)Which generally should be pronounced as weak form while reading aloud? ( )A.Auxiliary wordB.C.VerbD.Preposition5【多选题】 (2分)Phonics is a method for teaching and of the English language by develo ping learners' phonemic awareness—the ability to hear, identify, and manipulate phon emes—in order to teach the correspondence between these sounds and the spelling p atterns that represent them. ( )A.speakingB.writingC.listeningD.reading6【多选题】 (2分)Sound /k/ can be spelled as ? ( )A.kB.chC.ckD.c7【判断题】 (2分)Research has shown that children who have not developed reading skills by second gr ade, will experience an overall delay in learning throughout their school life. ( )A.对B.错8【判断题】 (2分)Understanding phonics will also help children know which letters to use when they ar e writing words. ( )A.对B.错9【判断题】 (2分)A lot of people start the journey of teaching kids phonics through the traditional ways, l ike teaching them to read, and this is the best way to follow. ( )A.错B.对10【判断题】 (2分)Written language can be compared to a code, so knowing the sounds of individual lett ers and how those letters sound when they’re combined will help children code word s as they read. ( )A.对B.错第六章测试1【单选题】 (2分)What does the first aspect of vocabulary learning involve according to Hedge (200 0)? ( )A.The sense relations among words.B.Connotative meaning.C.Denotative meaning.D.Denotative and connotative meaning.2【单选题】 (2分)Which is not the appropriate way of consolidating vocabulary? ( )A.Play a game.B.Categories.C.Spot the difference.D.Guessing.3【单选题】 (2分)Which is not a collocation? ( )A.See a movie.B.Watch a play.C.Movie.D.Look at a picture.4【多选题】 (2分)According to Hedge (2000), what does the second aspect of vocabulary learning invol ve? ( )A.Spelling and PronunciationB.Collocations.C.Synonyms, antonyms and hyponyms.D.Receptive and productive vocabulary.5【多选题】 (2分)What does knowing a word involve? ( )A.How and when to use it to express the intended meaning.B.Its meaning.C.Its spelling and grammatical properties.D.Its pronunciation and stress.6【多选题】 (2分)Which belong to vocabulary learning strategies? ( )A.Use a dictionary.B.Review regularly.C.Guessing from context.D.Presenting vocabulary.7【判断题】 (2分)Denotative meaning refers to those words that we use to label things as regards real o bjects, such as a name or a sign, etc. in the physical world. ( )A.错B.对8【判断题】 (2分)Antonyms refer to the sameness or close similarity of meaning or we can say that wor ds are close in meaning. ( )A.对B.错9【判断题】 (2分)Receptive/passive vocabulary refers to words that one is able to recognize and compr ehend in reading or listening but unable to use automatically in speaking or writing. ( )A.错B.对10【判断题】 (2分)Collocations refer to words that co-occur with high frequency and have been accepte d as ways for the use of words. ( )A.对B.错第七章测试1【单选题】 (2分)Deductive reasoning is essentially a approach which moves from the more gen eral to the more specific. ( )A.gameB.down-topC.traditionalD.top-down2【单选题】 (2分)is an approach that removes you, the teacher, from the main role of “explainer” and ex tends to the students the opportunity to question and discover the target grammar. ( )A.The guided discovery methodB.Mechanical practiceC.Deductive methodD.Inductive method3【单选题】 (2分)usually comes after mechanical practice. ( )A.The guided discovery methodB.Meaningful practiceC.Deductive methodD.Inductive method4【多选题】 (2分)Although a little less effective than inductive teaching, benefits to the deductive approa ch are: ( )A.It encourages faster learning of material and understand the meaningB.Time in the classroom is spent only on the language principle.C.Most material can be easily taught this way.D.Students can have lots of interaction with others in a meaningful context.5【多选题】 (2分)Although inductive teaching takes longer than deductive, many educators agree it i s a very efficient method in the long run. Benefits include: ( )A.Students rely on their critical thinking to figure out the language.B.Students can gain deeper understanding of the language.C.Students can get more interaction and participation among each other.D.No material can be easily taught this way.6【多选题】 (2分)Using prompts has proved to be an effective way of grammar practice. The prompts ca n be: ( )A.picturesB.tablesC.key wordsD.mines7【判断题】 (2分)The deductive and inductive teaching methods can be illustrated in this picture. ( )A.对B.错8【判断题】 (2分)That the students are asked to produce language based on pictures and key phrase s provided by the teacher is using chained phrases for storytelling. ( )A.对B.错9【判断题】 (2分)In mechanical practice the focus is on the production, comprehension or exchange o f meaning through the students “keep an eye on” the way newly learned structures ar e used in the process. ( )A.对B.错10【判断题】 (2分)Grammar practice is usually divided into two categories, mechanical practice and mea ningful practice. ( )A.错B.对第八章测试1【单选题】 (2分)Which is not involved in bottom-up processing while listening? ( )A.Recognizing phrases.B.Referring meaning from background knowledge.C.Recognizing structures.D.Recognizing sounds of words.2【单选题】 (2分)Which is not the stage of listening teaching? ( )A.While-listening.B.Predicting.C.Pre-listening.D.Post-listening.3【单选题】 (2分)Which is not the main listening difficulty of learners? ( )A.Quickly forget what is heard.B.Neglect the next part when thinking about meaning.C.Able to form a mental representation from words heard.D.Do not recognize words they know.4【多选题】 (2分)What are two models that are frequently used to describe different processes of listeni ng? ( )A.Top-up model.B.Top-down model.C.Bottom-up model.D.Bottom-down model.5【多选题】 (2分)Which belong to principles for teaching listening? ( )A.Focus on process.B.Combine listening with other skills.C.Focus on the comprehension of meaning.D.Grade difficulty level appropriately.6【多选题】 (2分)What are three main categories that affect the difficulty level of listening tasks accordin g to Anderson and lynch (1988)? ( )A.Context in which the listening occurs.B.Bottom-up and top-down approaches.C.Type of language used.D.Task or purpose in listening.7【判断题】 (2分)Bottom-up and top-down these two processes are mutually dependent. ( )A.对B.错8【判断题】 (2分)It is important to develop listening skills together with other skills because ordinarily list ening is not an isolated skill. ( )A.错B.对9【判断题】 (2分)Multiple-choice tests play a decisive role in helping students develop good listening ha bits and strategies. ( )A.错B.对10【判断题】 (2分)In the top-down model, listening for gist and making use of the contextual clues and ba ckground knowledge to construct meaning are emphasized. ( )A.对B.错第九章测试1【单选题】 (2分)Which is not the principle for teaching speaking? ( )A.Maximizing meaning interactions.B.Problem-solving activities.C.Personalizing practice.D.Contextualizing practice.2【单选题】 (2分)Which practice is not structure-based with a focus on forms? ( )A.Grammar learning.B.Syntax learning.C.Providing sufficient opportunities for students to develop fluency.D.Vocabulary learning.3【单选题】 (2分)Which of the following activities is often used to develop students’ speaking accurac y? ( )A.Acting out the dialogue in the text.B.Having discussions in groups.C.Describing people in pair.D.Identifying and correcting oral mistakes.4【多选题】 (2分)Like all the other skills, what strategies does speaking involve?( )A.Turn taking.B.Asking for clarification.C.Initiating a conversation.D.Ending a conversation.5【多选题】 (2分)Which belong to common features of spoken language according to Bygate (1987)? ( )A.Using devices such as fillers, hesitation device to give time to think before speaking.B.Taking short cuts, e.g. incomplete sentences.C.Using less complex syntax.D.Using fixed conventional phrases or chunks.6【多选题】 (2分)Which belong to typical speaking tasks? ( )A.Problem-solving activities.B.Dialogues and role-plays.C.Doing translation exercises.D.Information-gap activities.7【判断题】 (2分)Maintaining a balance between accuracy-based and fluency-based practices is essenti al in teaching speaking.( )A.对B.错8【判断题】 (2分)Speaking is the skill that the students will be judged upon most in simulated situation s. ( )A.错B.对9【判断题】 (2分)Problem-solving activities tend to be productive because there is a clear objective to b e reached or problem to be solved and require a higher level of language proficienc y. ( )A.错B.对10【判断题】 (2分)Designing speaking activities that maximize students’ opportunity to speak is one of th e central tasks for language teachers. ( )A.错B.对第十章测试1【单选题】 (2分)Which is not the teaching step of viewing teaching? ( )A.What message does the image transmit?B.What do you feel?C.What can you touch?D.What can you see?2【单选题】 (2分)Which is not the three-dimension paradigm by Serafini (2014)? ( )A.StructuralB.IntellectualC.IdeologicalD.Perceptual3【单选题】 (2分)What is the definition of Visual literacy? ( )A.With technology, images and visual presentations are flourishing more than ever.B.It means student's ability to “use, interpret, analyze, and think critically about visual images and the signi ficance of what they are seeing”.C.This involves exploring how ideas and emotions are expressed and the use of lighting to create an emoti onal or physiological point.D.Visual literacy is based on the idea that can be "read" and that meaning can be through a process of re ading.4【多选题】 (2分)Which are the teaching steps of viewing teaching? ( )A.What can you touch?B.What is the image trying to tell us?C.What can you see?D.What do you feel?5【多选题】 (2分)What are the pedagogical questions that the teacher can use in class to develop learn ers’ visual literacy? ( )A.How could you change/improve this image?B.What more can we find out?C.What does this image say to us?D.Where has this image come from?6【多选题】 (2分)What can be used as visual literacy clues to facilitate identifying the visual products? ( )A.ColorB.ShapeC.GestureD.Lighting7【判断题】 (2分)We need to consider the active viewer as well and engage the students' creative or cur ative responses to the image. ( )A.错B.对8【判断题】 (2分)One of the most effective ways to encourage information to make that important jump f rom the limited short-term memory to the more powerful long-term memory is to pair te xt with images. ( )A.错B.对9【判断题】 (2分)As these students travel on their road to fluency in English, images can provide an eff ective bridge in that learning process. ( )A.错B.对10【判断题】 (2分)Information presented visually is processed extremely quickly by the brain. ( )A.对B.错第十一章测试1【单选题】 (2分)When expectations are set up, what kind of process of reading is ready to begin? ( )A.ForcedB.PassiveC.NegativeD.Active2【单选题】 (2分)What does bottom-up model mean? ( )A.The teacher should teach the background knowledge first, so that students equipped with such knowled ge will be able to guess meaning from the printed page.B.The teacher teaches reading by introducing vocabulary and new words first and then going over the tex t sentence by sentence.C.None of the above.D.Not only linguistic knowledge but also background knowledge is involved in reading.3【单选题】 (2分)Which is not the reading skill that the learners should be developed in reading clas s? ( )A.Making prediction based on vocabulary or titleB.Guessing the word’s meaningC.Cooperating with othersD.Making inference4【多选题】 (2分)What are the principles for reading teaching? ( )A.Prediction is a major factor in reading.B.Students should be encouraged to respond to the content of a reading text, not just to the language.C.Students need to be engaged with what they are reading.D.Good teachers exploit reading texts to the full.5【多选题】 (2分)What are the models for reading teaching? ( )A.Top-down ModelB.Discovery ModelC.Interactive ModelD.Bottom-up Model6【多选题】 (2分)Find out the reading skills that the learners should be cultivated in reading class. ( )A.Making inferenceB.SkimmingC.ScanningD.Guessing the word’s meaning7【判断题】 (2分)As with everything else in lessons, students who are not engaged with the reading tex t will not actively interested in what they are doing. ( )A.错B.对8【判断题】 (2分)In the Top-down Model, the teacher teaches reading by introducing vocabulary and ne w words first and then going over the text sentence by sentence. ( )A.错B.对9【判断题】 (2分)According to the Interactive Model of reading, when one is reading, the brain receive s visual information, and at the same time, interprets or reconstructs the meaning tha t the writer had in mind when he wrote the text. ( )A.错B.对10【判断题】 (2分)Reading comprehension involves extracting the relevant information from the text as e fficiently as possible, connecting the information from the written message with one’s o wn knowledge to arrive at an understanding. ( )A.错B.对第十二章测试1【单选题】 (2分)Which will not help teachers motivate students to write? ( )A.Encourage collaborative group writing as well as individual writing.B.Leave students less room for creativity and imagination.C.Make the topic of writing as close as possible to students' life.D.Provide constructive and positive feedback.2【单选题】 (2分)What product-oriented method of teaching writing mean? ( )A.Writing activities should serve to encourage a process of brainstorming, drafting, writing, feedback, revis ing and editing, which proceeds in a cyclical fashion resembling the writing process of a real writer.B.It pays great attention to the accuracy of the final product but ignores the process, which the students g o through to reach the final goal.C.The process approach to writing does not only pay attention to what students do while they are writing, i t also attaches great importance to what they and the teacher do before they start writing and after they f inish writing.D.What really matter is the help that the teacher provides to guide students through the process that they undergo when they are writing.3【单选题】 (2分)What does process approach to writing mean? ( )A.What really matter is the help that the teacher provides to guide students through the process that they undergo when they are writing.B.Encourage feedback both from themselves.C.Do not give students time to discover what they want to say as they write.D.Teaching writing pays great attention to the accuracy of the final product but ignores the process.4【多选题】 (2分)Which principles can help teachers motivate students to write? ( )A.Leave students enough room for creativity and imagination.B.Provide opportunities for students to share their writings.C.Make the topic of writing as close as possible to students' life.D.Encourage collaborative group writing as well as individual writing.5【多选题】 (2分)Which principles will motivate students to write? ( )A.Give students a sense of achievement from time to time.B.Leave students less room for creativity and imagination.C.。
Hindawi Publishing CorporationJournal of PregnancyVolume2010,Article ID329618,5pagesdoi:10.1155/2010/329618Case ReportConservative Management of Placenta Accreta ina Multiparous WomanJennifer C.HuntDepartment of Obstetrics,Gynecology,and Reproductive Sciences,University of Manitoba,Women’s Hospital,Room WS125,735Notre Dame Avenue,Winnipeg,MB,Canada R3E0L8Correspondence should be addressed to Jennifer C.Hunt,jen hunt@shaw.caReceived13July2010;Accepted27August2010Academic Editor:Federico PrefumoCopyright©2010Jennifer C.Hunt.This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use,distribution,and reproduction in any medium,provided the original work is properly cited.Placenta accreta refers to any abnormally invasive placental implantation.Diagnosis is suspected postpartum with failed delivery ofa retained placenta.Massive obstetrical hemorrhage is a known complication,often requiring peripartum hysterectomy.We reporta case of presumed placenta accreta in a patient following failed manual removal of a retained placenta.We describe an attemptat conservative management with methotrexate in a stable patient desiring future fertility.Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction,requiring both a hysterectomy and small bowel resection.In hemodynamically stable patients,conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate.However,ongoing close observation is required to identify complications.1.IntroductionPlacenta accreta is an obstetrical complication associated with significant maternal morbidity and mortality.It is caused by a defect in the decidua basalis resulting in an abnormally invasive placental implantation[1].This dis-ruption is often related to previous uterine scars,including caesarean sections and prior uterine curettage[2].Other risk factors associated with placenta accreta are multiparity(>6 pregnancies);placenta previa;prior intrauterine infections; elevated maternal serum alpha-fetoprotein;and maternal age over35years[2–4].Histologically,placenta accreta is identified by trophoblastic invasion of the myometrium in the absence of intervening decidua[1].The spectrum includes invasion of the superficial myometrium(accreta), invasion into deeper myometrial layers(increta),and inva-sion through the serosa and/or adjacent pelvic organs (percreta)[5].Ideally,the diagnosis might be evaluated antenatally in high-risk pregnancies and suspected using ultrasound [1].This could allow for predelivery planning to reduce maternal morbidity and mortality.Unfortunately,most cases are identified only at the time of delivery when forcible attempts at manual removal of the placenta are unsuccessful [6].Severe postpartum hemorrhage may result and may lead to complications such as massive transfusion of blood products;DIC;acute renal failure;infectious morbidities; ARDS;loss of fertility[1].Mortality is as high as7%[7].Traditionally,caesarean hysterectomy at the time of delivery has been the preferred management strategy for placenta accreta[1].Not only does this approach preclude future fertility,but it is also a procedure synonymous with significant perioperative risks[7].For women who wish to conserve their reproductive function,other treatment options have been described.In some settings,uterine con-servation(with the placenta left in situ)may be an alternative strategy[5–9].Adjuvant therapy with methotrexate has also been used to expedite resorption of placental tissue[6–8].2.The CaseA32-year-old multiparous woman(gravida7,para6) presented to a nursing station in Arviat,Nunavut at34weeks gestational age in preterm labour.The patient subsequently delivered precipitously prior to transfer to a tertiary carecentre.Her obstetrical history was significant for six previous vaginal deliveries and two neonatal deaths secondary to an autosomal recessive metabolic disorder.She had beentransferred to a tertiary centre in Winnipeg twice during hercurrent pregnancy for episodes of antepartum hemorrhage.At19weeks,she was admitted to hospital for observationand was discharged home after24hours.At32weeks,shewas admitted again for vaginal bleeding.On this admission,her hemoglobin was78g/L.A subsequent fetal assessmentconfirmed an unremarkable right anterolateral placenta thatwas clear of the internal os and an active fetus with abiophysical profile score of8/8.No evidence of abruption wasnoted.She was discharged home.Following spontaneous vaginal delivery,the placentafailed to deliver over the next eight hours.The patient wastransferred to a community hospital in northern Manitobafor manual removal.Upon arrival,she was hemodynamicallystable without significant vaginal bleeding.The patient wastaken to the operating room to undergo manual removal ofthe retained placenta.The surgeon was only able to removesmall fragments of tissue as the remainder of the placenta wasdensely adherent to the myometrium.Intraoperative vaginalbleeding occurred and was managed with a combinationof vigorous fundal massage,uterine packing,oxytocin,andcarboprost.The bleeding settled over the following18hours,at which point the packing was removed.She receivedprophylactic intravenous antibiotics and three units ofpacked red blood cells.On postpartum day2,an abdominalultrasound was performed.A large12cm soft tissue mass wasvisualized at the uterine fundus that was felt to be invadingthe myometrium.On postpartum day3,only mild vaginal bleeding hadoccurred,and the patient was transferred to a tertiarycentre in Winnipeg with a presumed diagnosis of placentaaccreta.Upon arrival,her serumβhCG was16320IU/L.The following day,she received a single dose of75mg ofmethotrexate intramuscularly and was started on a courseof prophylactic cephalexin.Management then continued asan outpatient with twice-weekly visits to clinic to monitorfor infection and bleeding.By postpartum day16,her serum βhCG had decreased to1447UI/L and her hemoglobin to 79g/L.Upon assessment in clinic that day,she describedongoing mild-to-moderate vaginal bleeding and was foundto have an isolated temperature of38.5◦C.The patient wasadmitted to hospital for48hours.Blood cultures were taken,two units of packed red blood cells were transfused,andoral cephalexin was continued.An abdominal ultrasound(Figure1(a))revealed persistent retained placental tissue.Over the next week,the patient was again followedin an outpatient setting(Figure1(b)).A repeatβhCG was479UI/L.On postpartum day26,she reported afive-dayhistory of nausea,vomiting,reduced oral intake,abdom-inal pain with eating,and failure to pass stool orflatus.Vaginal bleeding remained unchanged.On examination,she was found to have significant abdominal distensionand tenderness on palpation.She was afebrile with aheart rate of100beats per minute and blood pressure of96/58.The patient was admitted for investigation.She hadevidence of leukocytosis(white blood cells21.7×109/L),∗∗1SRI3/CRI31D8.6cm(a)1SRI3/CRI31D10.24cm∗∗(b)Figure1:Transabdominal ultrasound image taken on postpartum day17.This view of the uterine fundus demonstrates significant persistence of retained placental tissue approximately two weeks after methotrexate administration.SerumβhCG was1571UI/L. The distinction between the placental mass(dotted line)and myometrium(asterisk)is shown.Transabdominal ultrasound image taken on postpartum day24.This view of the uterine fundus shows significant persistence of retained placental tissue approxi-mately three weeks after methotrexate administration.SerumβhCG was479UI/L.The distinction between the placental mass(dotted line)and myometrium(asterisk)is depicted.thrombocytosis(platelets560×109/L),and pre-renal failure (creatinine140μmol/L,urea12.6mmol/L).An abdominal plainfilm demonstrated dilated loops of bowel and multiple air-fluid levels consistent with a small bowel obstruction.At this time,blood cultures from the previous admission had grown Prevotella corporis.The patient was admitted for hydration,bowel rest, pain management,and intravenous antibiotics.Intravenous cefoxitin1g every eight hours was chosen based on the blood culture sensitivities.A CT abdomen confirmed a mechanical small bowel obstruction with a possible adhe-sion noted between the uterine fundus and small bowel (Figure2).Placental tissue was again noted at the fundus.In consultation with the general surgery service,the obstruction was to be managed conservatively.A consultation was also requested with a senior gynecologist regarding management of the retained placental tissue.The prevailing consensusFigure2:CT scan of the patient’s abdomen on postpartum day27demonstrating the uterus with the retained placenta was demonstrated(arrow).The presence of dilated,fluidfilled loops of small bowel with collapse of the large bowel confirmed the diagnosis of a mechanical small bowel obstruction.A possible adhesion was noted between the uterine fundus and the bowel(not shown here). was that an endomyometritis had occurred secondary to the placenta accreta and had progressed to bacteremia, peritonitis,and intestinal ileus.The patient was consented for an elective dilatation and curettage to be carried out within the next few days.She was received informed consent with respect to possible complications,including laparotomy and hysterectomy.On postpartum day29,the patient was taken to the operating room for a dilatation and curettage.During the procedure,a uterine perforation identified as bowel was pulled through the cervix with forceps.The surgeon pro-ceeded to laparotomy.A large necrotic defect with purulent material was noted at the uterine fundus.Swabs were taken for culture and subsequently grew Prevotella species.Further-more,the small bowel and left ovary were adherent to the uterus.Surgical management of thefindings included a total hysterectomy,in addition to an Intraoperative consultation with a general surgeon for a small bowel resection with primary reanastomosis.Blood loss was100mL.By the evening of postoperative day0,the patient had become increasingly tachycardic and hypotensive.Urine output decreased dramatically,and significant abdominal distension was found.Serum hemoglobin decreased from 93g/L to81g/L.Postoperative hemoperitoneum was diag-nosed.She received volume resuscitation with crystalloid, colloid,and packed red blood cells.The patient returned to the operating room for an emergency exploratory laparo-tomy.Upon entry,bleeding was noted from the right infundibulopelvic pedicle and left vaginal cuffangle.All bleeding pedicles were reinforced,and good hemostasis was achieved.Postoperatively the patient did well.She received further bowel rest with total parenteral nutrition until she was consistently passingflatus and able to tolerate oral intake.A mild wound infection developed on postoperative day4,and antibiotic therapy was changed to oral amoxicillin/clavulin based on culture sensitivities to cover Prevotella(blood),E. coli(wound),and non-hemolytic streptococcus(wound). The patient wasfinally discharged from hospital in good condition on postoperative day10.Pathology confirmed the presence of necrotic and infarcted villous tissue at the uterine fundus consistent with placenta accreta.Acute and chronic serositis of the small bowel was noted.Incidentally,the cervix was found to have high-grade dysplasia.3.DiscussionThe incidence of placenta accreta approximates1in1000 deliveries and has been increasing largely due to the global increase in caesarean deliveries.Patients at risk for abnormal placentation should be assessed antenally by ultrasonogra-phy,with or without adjunct magnetic resonance imaging if indicated[1].The women at the highest risk are those with placenta previa in the current pregnancy and a history of prior caesarean delivery.Optimal management of abnormally invasive placenta-tion remains unclear.Traditionally,primary hysterectomy at the time of caesarean section has been the mainstay of therapy particularly in cases where the diagnosis has been discovered antenatally[10].This procedure has been asso-ciated with significant maternal morbidity and mortality.In a recent systematic review,emergency postpartum hysterec-tomy was found to be associated with maternal morbidity in56%of cases and with a mortality rate of3%[11].In addition to obvious loss of fertility,complications include injury to the gastrointestinal or urinary tracts,infection, as well as massive obstetrical hemorrhage and its sequelae [6,11].Furthermore,it has been recognized that planned caesarean hysterectomy is associated with fewer perioperative complications compared to emergent procedures[12].When an extirpative approach is utilized to excise the pla-centa from the uterus,severe bleeding necessitating urgent hysterectomy may occur[7].This scenario is encountered when placenta accreta is diagnosed peripartum following failed removal of a retained placenta.Several reports have described the use of more conser-vative strategies aimed at preserving the uterus and main-taining future fertility[5–9].This approach involves leaving the placental tissue in situ providing that the patient remains hemodynamic stable,without life-threatening hemorrhage, and with a desire for ongoing fertility.Presuming the diagno-sis at placenta accreta can be anticipated,efforts to minimize blood loss may be utilized.These might include having blood products and uterotonic agents available for delivery;blood cell saver technology;compression sutures;uterine packing; selective arterial embolization and/or balloon occlusion;and uterine and/or hypopgastric artery ligation[1].Although prenatal imaging may be useful,ultrasoundfindings sugges-tive of placenta accreta may not always be appreciated.In one review,only44%of cases were suspected on the basis of antenatal ultrasound[9].Methotrexate has also been described an as adjuvant therapy for the conservative management of placenta accreta [1,6–9].It has been hypothesized that methotrexate actsby inducing placental necrosis and expediting a more rapid involution of the placenta[13].This contradicts the belief that methotrexate acts only on rapidly dividing cells,given that trophoblast proliferation is not felt to occur at term [14].Thus,there is controversy as to the effectiveness of methotrexate as an adjuvant treatment.Also,there is a lack of consensus regarding optimal dosing,frequency,or route of administration.In this particular case,a single dose of50mg per m2of body surface area was used,similar to the protocol used in the management of ectopic pregnancy at our centre.In a recent review,conservative management was utilized in167cases of placenta accreta/percreta.[9].The failure rate was22%and hysterectomy,either primary or delayed, was required mostly for severe hemorrhage.Severe maternal morbidity,including one maternal death,occurred in6%of cases.The death was attributed to aplasia and nephrotoxicity secondary to intraumbilical administration of methotrexate. This case highlights the adverse effects that may occur following even a single dose of adjuvant methotrexate.Another retrospective review of60cases of placenta accreta found similar outcomes among women managed conservatively with the placenta in situ whether or not adjuvant treatments were used[6].Of the twenty-six women managed without the use of additional therapies,22(85%) had a favourable outcome.In the remaining4cases,conser-vative management failed,and a hysterectomy was required either due to severe hemorrhage or infection.An additional 22women received methotrexate.Treatment failed in5 patients;thus,hysterectomy was avoided in77%of cases.Kayem et pare two strategies of management in their centre over two different time periods[7].In the first time period,a policy of removing all placenta tissue was employed(13cases).In the second,the standard of care changed to leaving the placenta in situ(20cases).The hysterectomy rates in thefirst and second time periods were 85%and15%,respectively.Most cases occurred in women where the diagnosis was recognized at the time of delivery and were subsequent to severe hemorrhage or infection.Although conservative management of placenta accreta appears to be successful at preventing hysterectomy in most cases,there is still potential for morbidity.If such an approach is used,intensive monitoring for complications is required.Women may continue to be at risk for weeks to months after delivery.Sentilhes et al.reported a median period to delayed hysterectomy of22weeks[9].Fever is a commonly reported complication.Most cases are secondary to endomyometritis orflorid sepsis;however, fever may also represent an inflammatory response to tissue necrosis in the absence of an infectious source[13]. Prophylactic broad-spectrum antibiotic therapy may reduce the incidence of infectious morbidity[6–8].In our case, the patient developed Prevotella corporis bacteremia despite the use of prophylactic antibiotics.Prevotella species are anaerobic gram-negative bacilli that can be implicated in puerperal infections[15].Therapy must be adjusted based on culture sensitivities as up to one third of strains may be resistant toβ-lactam antimicrobials[15].Vaginal bleeding may also complicate management for several months following delivery.In Timmermans’review,fever and vaginal bleeding each occurred in35%of patients and were the inciting factors leading to hysterectomy in all but one(92%)of the patients with treatment failure[6]. Similarly,Sentilhes et al.reported delayed vaginal bleeding as the reason for hysterectomy in8of the36treatment failures (22%),while sepsis was implicated in7cases[9].Kayem et al. describe a significantly lower occurrence of disseminated intravascular coagulopathy,presumably secondary to severe hemorrhage,in women managed with the placenta in situ (5%)compared to cases where the placental tissue was removed(39%)[7].Another controversy surrounding the use of methotrex-ate in the management of placenta accreta has been the utility of monitoring serumβhCG.The prognostic implications of decreasingβhCG levels following administration of methotrexate are better described in the setting of ectopic pregnancy.For placenta accrete,it is not clear whether decreasing levels correlate with the rate of involution of placental tissue.In one study,the serumβhCG levels decreased with a half-life of5.2days in women managed by leaving the placenta in situ and did not vary with the volume of remaining tissue[16].Another report described a half-life of serumβhCG of5.8days in cases of retained placenta managed with methotrexate[17].4.ConclusionWe report a case of placenta accreta in a multiparous patient that was conservatively managed with the placenta in situ and adjuvant methotrexate.Although initially the patient did well,she developed severe endomyometritis at the placental site that spread to involve the small bowel,a rare complication not previously reported by other authors.The conservative approach failed as a subsequent hysterectomy, and bowel resection were required.Furthermore,despite the significant decrease in the serumβhCG levels,a large placental mass persisted as evidenced by repeat ultrasound examinations during her management.This case depicts a common complication associated with this approach to treatment of placenta accreta as well as the need for intensive monitoring.Despite the use of pro-phylactic antibiotics,our patient developed endomyometritis and bacteremia.Nonetheless,experience in the literature suggests that conservative management of placenta accreta may be valid in select patients with favourable outcomes. Conflict of InterestsThe patient described in this paper has provided written consent for its publication.The author has no conflict of interests to disclose.AbbreviationsARDS:Acute respiratory distress syndromeβhCG:β-human chorionic gonadotrophinDIC:Disseminated intravascular coagulopathyCT:Computed tomography.References[1]Y.Oyelese and J. 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