[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-113-1-maternal-pediatric-021":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":33,"lastmod":63},"產兒科護理學","maternal-pediatric",{"id":7,"webId":8,"year":9,"session":10,"subject":4,"number":11,"stem":12,"options":13,"answer":18,"answerNote":19,"images":20,"explanation":21,"explanationDeep":22,"topics":23,"freq":26},"nurse-113-1-產兒科護理學-021","nurse-113-1-maternal-pediatric-021",113,1,21,"接受子宮頸環紮術（cervical cerclage）之孕婦狀況，下列何者最適合？",{"A":14,"B":15,"C":16,"D":17},"上一胎足月產但此胎妊娠16週，子宮頸口擴張4公分","前兩次均在妊娠21週時無痛性流產，此胎在16週子宮頸長度3.3公分","妊娠18週有破水且有規則宮縮痛，內診發現子宮頸口擴張2公分","前胎31週早產，此胎在28週例行性超音波發現子宮頸長度1公分","B",null,[],"本題考點在於子宮頸環紮術（cervical cerclage）的適應症判斷。此手術用於子宮頸閉鎖不全（cervical incompetence）——即無痛性、反覆的中期妊娠流產或早產，故最適合的是 B「前兩次均在妊娠 21 週無痛性流產、此胎 16 週子宮頸長 3.3 公分」，其『反覆中期無痛性流產』的病史正是典型適應症，且目前週數早、子宮頸尚有長度，環紮可預防再度早發性擴張。A「此胎 16 週子宮頸口已開 4 公分」擴張過大、可能已破水或難以縫合，時機與條件不佳。C「18 週已破水且有規則宮縮痛、子宮頸開 2 公分」已進入活動性流產且破水，環紮為禁忌。D「28 週例行超音波發現子宮頸長 1 公分」週數過大、已近可存活期且非典型適應症。故正解為 B。","臨床延伸：子宮頸閉鎖不全的特徵是『無痛性』子宮頸擴張，導致中期妊娠反覆流產，與有痛性宮縮的早產不同。環紮術（如 McDonald 或 Shirodkar 術式）通常於妊娠 12～14 週施行（history-indicated），或在超音波發現子宮頸縮短時施行（ultrasound-indicated）。禁忌包括已破水、有感染、活動性子宮收縮、明顯陰道出血或胎兒異常。故判斷適應症的關鍵在——病史為反覆無痛性中期流產、週數尚早、無破水無感染無規則宮縮，B 完全符合這些條件。",[24,27,29,31],{"term":25,"count":26},"子宮頸環紮術",2,{"term":28,"count":26},"子宮頸閉鎖不全",{"term":30,"count":10},"無痛性反覆中期流產",{"term":32,"count":10},"手術適應症與禁忌",[34,38,43,48,53,58],{"webId":35,"stem":36,"number":37,"year":9,"session":10},"nurse-113-1-maternal-pediatric-022","有關妊娠糖尿病之敘述，下列何者正確？",22,{"webId":39,"stem":40,"number":41,"year":9,"session":42},"nurse-113-3-maternal-pediatric-018","有關新生兒篩檢的敘述，下列何者正確？",18,3,{"webId":44,"stem":45,"number":46,"year":47,"session":26},"nurse-114-2-maternal-pediatric-012","吳女士，G 1 P 1 ，剖腹產後第 2 天，詢問：「我肚子脹脹的、不舒服，可以不要下床嗎？」下列護理措施何者最適當？",12,114,{"webId":49,"stem":50,"number":51,"year":52,"session":10},"nurse-106-1-maternal-pediatric-010","陳女士，懷孕 26 週，下列何項血液變化為正常？",10,106,{"webId":54,"stem":55,"number":56,"year":57,"session":10},"nurse-107-1-maternal-pediatric-054","有關雷氏症候群（Reye’s syndrome）病童的臨床症狀，下列敘述何者正確？",54,107,{"webId":59,"stem":60,"number":61,"year":62,"session":26},"nurse-108-2-maternal-pediatric-008","下列何種方式是依據懷孕婦女子宮底高度位置推估預產期？",8,108,"2026-09-04",1788510750827]