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1.Screening
1.1.Inclusion Criteria

Inclusion criteria

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1.2.Exclusion Criteria

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刘义彬

Date

2018-9-27 yyyy-mm-dd

2.Baseline
2.1.Medical History

4 小时

Average times of menstrual onset a year

11.7 次/年

Average menstrual cycle

31 天(days)

Menarche time

15 岁(years)

The time of last Menstruation

2018-8-25 年、月、日(yyyy-mm-dd)

The time of menstrual onset before the last one

不详 年、月、日(yyyy-mm-dd)

Disease or surgery name

剖宫产

Date of the confirmation or the surgery

2013年 年/月/日(yyyy-mm-dd)

Date

2018-9-27 yyyy-mm-dd

2.2.General information

Date of signing the informed consent

2018-9-27

Date of birth

1988-12-27 yyyy-mm-dd

Age

29 Years

Education background

University

Occupation

Other

Other (Description)

职员

2.3.Physical examination

Vulva

Normal

Description in detail for abnormal

--

Vagina

Normal

Description in detail for abnormal

--

Uterine neck

Normal

Description in detail for abnormal

--

Corpus uteri

Normal

Description in detail for abnormal

--

Adnexa uteri

Left side

Normal

Description in detail for abnormal

--

Right side

Abnormal

Description in detail for abnormal

探及6.84*4.58*6.23cm

Weight

卧床 kg

Hight

卧床 mm

Systolic pressure (SP)

101 mmHg

Diastolic pressure

74 mmHg

Temperature

36.2 degree Celsius

Pulse rate

74 次/分

Breath frequency

18 次/分

Doctor signature

刘义彬

Date

2018-9-27 yyyy-mm-dd

2.4.Blood Routine Tests

WBC

-- ×109 /L

NEUT%

-- %

LY%

-- %

MONO%

--

RBC

-- ×10^12 /L

HGB

-- g/L

PLT

-- ×10^9 /L

Researcher signature

--

Date

-- yyyy-mm-dd

2.5.Urine Routine Test

Acidity and allkalinity

pH value

--

Urine protein

Urine red cell

Urine WBC

Urine glucos

Urine Bilirubin

Urine HCG

KET

SG

--

UBG

NIT

Date of test

-- yyyy-mm-dd

2.6.Blood Biochemical items Tests

ALT

-- U/L

AST

-- U/L

GGT/γ-GT

-- U/L

ALP

-- U/L

TBIL

-- μmol/L

DBIL

-- μmol/L

IBIL

-- μmol/L

ALB

-- g/L

UA

-- umol/L

UREA

-- mmol/L

TC

-- mmol/L

Cr

-- umol/L

TG

-- mmol/L

HDL

-- mmol/L

LDL

-- mmol/L

CK

-- U/L

CK-MB

-- U/L

LDH

-- U/L

K

-- mmol/L

Na

-- mmol/L

Cl

-- mmol/L

Ca

-- mmol/L

Glu

-- mmol/L

Date

-- yyyy-mm-dd

2.7.Coagulation Function Tests

Prothrombin time

--

Thrombin time (TT)

--

Activated partial thromboplastin time (APTT)

--

Fibrinogen (FIB)

-- g/L

Date of examination

-- yyyy-mm-dd

2.8.HBV/HCV/HIV/Syphilis Markers Test

HBV

HCV

Date of test

-- yyyy-mm-dd

2.9.Blood Gas Analysis

Date of examination

2018-9-27 (yyyy-mm-dd)

LAC

2.33 mmol/L

SBE

-- mmol/l

P02

344 mmHg

PCO2

36.1 mmHg

HCO3

-- mmol/l

SO2

--

PH

7.384

2.10.D-dimer Test

--

2.11.HCG Test

-- mIU/mL

Urine HCG

Not detected

2.12.Visual Analogue Scale

Pain Visual Analogue Score

Extremely pain intolerable

2.13.Image Examinations

32

-- cm*cm*cm

--

-- cm

-- cm

Date of examination

-- yyyy-mm-dd

Abdomen CT examination

Not tested

Description in detail for abnormal

--

Date of examination

-- yyyy-mm-dd

--

2.14.Other Tests
3.In the process of the treatment
3.1.Treatment Record

cm

°

4.Follow-up
4.1.Physical examination

BG Puncture site

Temperature

Systolic pressure (SP)

mmHg

Diastolic pressure (DP)

mmHg

Heart Rate, HR

次/分

Blood pressure

mmHg

4.2.Blood Routine Test

WBC

×109 /L

NEUT%

%

LY%

%

MONO%

RBC

×10^12 /L

HGB

g/L

PLT

×10^9 /L

Date

yyyy-mm-dd

4.3.D-dimer test

D-dimer

D-dimer

Date of test

yyyy-mm-dd

4.4.Visual Analogue Scale

Pain Visual Analogue Score

5.Management system of participants

sample collection

Volume

ml

Time of collection

yyyy-mm-dd-hh-min.

Label Number of the sample

6.ADR/ADE management system

Is there any adverse event?

Severity

Within 30 minites or not?

Begin time at

年/月/日(yyyy-mm-dd)

Time of stop

年/月/日(yyyy-mm-dd)