妊 高 征 - 哈尔滨医科大学.pptVIP

Chapter 12 AntepartumHemorrhage 哈医大第二临床医学院 邱晓红 一.? Placenta PreviaDefinition ：  After 28 pregnant weeks placental implantation over the cervical os or in the lower uterine segment. Etiology ： The cause of placenta previa remains unclear . but possi-ble etiologic factors. as 1、poorly vascularized endometrium. 2、large placenta. 3、Abnormal placenta 4、placenta implanted in the lower  uterine segment Classification1、cmplete placenta previa.2、partial placenta previa3、marginal placenta previa  Clinical manifeslation1、symptoms： sudden painless vaginal bleeding ,bleeding results from detachment of placental tissue as the lower uterine lengthens and the subsequent Inability of the lower segment to contract , vessels contrict to stop the bleeding 。2、signs: uterus usually is soft and  nontender , the fetal presenting  part is not into the pelvic inlet 。 Diagnosis 1、History, After 28 pregnant  weeks , sudden painless  intermittent vaginal bleeding .2、Sings , anaemia or shock . 3、Vaginal examination  preparations for transfusion  opreration delivery , if the  diagnosis of placenta previa is sufficient or profuse vaginal  bleeding , the vaginal examina- tion should be omitted .4、ultrsound examination .5、examination of the placental and  fetalmembrane After delivery. Differential Diagnosis Complications 1、postpartum bleeding 2、placenta accreta3、infection4、amniotic fluid embolism 5、prematurity and perinatal  fetal death  treatment 1、Expectant Therapy2、vaginal delivery cesarean section 二、Placenta Abruption Definition：the premature separ-ation of a normally implanted placenta from the uterus After 20 pregant weeks 。 Etiology1、Local vascular injury results in  vascular rupture into the decidua  basalis, bleeding , and hematoma formation。2、Mechanical fa