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leo 發問時間: 社會與文化語言 · 7 年前

病例翻譯~~ 急需 誰能給我答案!?

(Chief complaunts)

Pregnancy at 38+5 weeks with labor signs in the morning.

(History of present illness)

This 29 year old woman was pregnant at 38+5 weeks gestation; she felt regular low abdomen pain in this morning. So she visited our DR for evaluation and managemet. FHR monitoring showed normal FHR pattern and regular uterine contractility; the physical vaginal examination revealed that the cervical dilatation was 1 cm, the effacement was about 30%,station -3. Tracing her OBS history, she was G4P2AA1; EDC was 102-03-27 and she underwent regular prenatal care in our clinic, and no special problem was noted in maternal-fetal field. Therefore, under the impressionof pregnancy at 38+5 weeks in labor, she admitted for preparation of vaginal delivery.

(Past medical and surgical history)

Hypertension: (-), Diabetes mellitus: (-), Coronary artery disease: (-), S/P D&C for AA.

S/P NSD x 2

(Personal history)

Denies cigarette smoking or drinking.

Travel history ( present 3 months ) : Nil .

GYN and OBS history :

1.Marital status : married. G5P2AA1

2.LMP : 101-06-20, EDC : 102-03-27.

3.Interval : regular.

4.Dysmenorrhea : (-) ; menorrhagia : (-).

5.Past STD : (-).

Social economic status

Occupation : housewife.

Marriage : marryed.

Economy : middle class.

Psychological status : mild anxiety status.

Physical vaginal examination :

Discharge : Bleeding (-), scanty amount, rupture of membrances (-), OS: 1 cm; effacement : 30%; station: -3 ; consistence : soft.

(Neurological examination)

Neurological examination :

Clear consciousness

Alert mental status

No apperent neurologic problem

3 個解答

評分
  • 7 年前
    最佳解答

    首先讓我在這裡向你說聲恭喜。

    主要的症狀:懷孕了三十八加五個禮拜,今天早上有快要生的跡象。

    今天的情況:他二十九歲的太太已經懷孕了三十八加五個禮拜。今天早上她感到有輕微的陣痛,就來到我們的產科作檢查。檢查的結果顯示胎兒的心跳(FHR),子宮的收缩都正常。陰道檢查顯示子宮頸已經擴大了一厘米,薄了百分之三十,已經是待生的第三期。她的產科記錄是 G4P2AA1 預產期是2013年三月二十七日。她一直都有到我們的診所做例行的檢查,母親胎兒都沒有發現任何異常。基於她懷孕已經是三十八加五個禮拜,我們就把她送進了自然生產的產房。過往的醫療和手術病歷:

    沒過度緊張,沒糖尿症象,冠動脈沒事,S&D (曾刮宮?),自然生產過兩次。個人資料: 否認有吸煙喝酒。最近三個月沒出門。婦產科的記錄:已婚,G4P2AA1。

    最後經期:民國101-6-20,預產期:102-3-27。經期正常,沒經痛,沒月經過多,沒性病。

    社會經濟狀況:已婚,家庭主婦,中等收入。

    心理狀況:有輕微的焦慮。

    陰道檢查結果:沒大量出血,只看見一點點,羊水沒破,子宮頸大擴了一厘米,薄了百分之三十,是產前第三期,一切看起來柔軟。

    神經檢查:神智清晰,警覺敏銳,沒有觀察到什麼問題。

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  • 7 年前

    you have to translate this?! Yes

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  • 7 年前

    I hope you're not trying to become a doctor... but, then, why on earth would

    you have to translate this?!

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