《产后出血-2016八年制》.pptVIP

Postpartum Hemorrhage Zhu Jieping Shanghai Jiaotong University Affiliated Sixth Peoples Hospital, Dept of Obs Gyn Definition A blood loss of 500 ml or more in the first 24 hours after delivery A description, not a diagnosis The primary cause of maternal mortality Predisposing factors and causes Uterine atony Placenta abnormity Trauma to the genital tract Coagulation defects 1. Uterine Atony (子宫收缩乏力) Obstetric factor Prolonged labor 滞产 Precipitate delivery (delivery 3 hrs) 急产 Pregnant complications placenta previa placental abruption chorioamnionitis(绒毛膜羊膜炎) Oxytocin-induced labor引产 Augmented labor 催产 1. Uterine Atony (子宫收缩乏力) Systemic factor Psychological factors Tocolytic agent 宫缩抑制剂 Conduction analgesia(镇痛分娩) Uterus factor Overdistended uterus: large fetus, twins, hydramnios Uterus myoma, history of CS, myomectomy High parity Incidence Incidence of PPH PPH of Uterine Atony 2. Placental factors Retained placental tissue Placenta Succentuiate lobe (副叶胎盘) Embryolema (胎膜) Abnormally adherent Accreta, increta, percreta (粘连，植入，穿透) 3. Trauma to the genital tract Causes Precipitate delivery急产, large fetus Unthorough Hemostasis (止血) Laceration of perineum, vagina, cervix Uterine Rupture Haematomas 4. Coagulation defects Pregnant complications Amniotic fluid embolism (AFE, 羊水栓塞) Hypertensive disorders in pregnancy Placental abruption Still birth Haematological diseases Idiopathic thrombocytopenic (ITP, 特发性血小板减少性紫癜), Aplastic anemia (AA, 再生障碍性贫血) Clinical manifestation Vaginal bleeding 出血发生时间 有无凝血块 血肿？ Symptoms of shock Diagnosis Estimating blood loss Visual estimation Objective measurement 称重法 面积法 10cm*10cm=10ml Shock index HR/SBP=0.5 normal 1.0 blood loss 20~30% 1.5 blood loss 30~50% 2.0 blood loss 50% Diagnosis Cause analysis Uterine Atony: a soft, boggy uterus 正常胎儿娩出后宫底位置？ Placental factors 正常胎盘娩出时间？ 如何检查？ Diagnosis Cause analysis T