培训课件--胎盘早剥与前置胎盘.ppt

diagnosis Painless vaginal bleed: first bleeding episode is 29~30 weeks Ultrasonography: benefit in localizing the placenta and diagnosis placenta previa 病史与症状 查体与体征 关于阴道检查 超声检查 产后检查胎盘及胎膜 注意：妊娠中期不宜过早作出诊断 鉴别诊断 胎盘早剥 其他原因引起的产前 出血 Caution Double setup vaginal examination No digital vaginal or rectal examination is preformed in case of placenta previa . Only as a final and definitive event and only under conditions of double set up. This procedure involves careful evaluation of the cervix in the operation room with full preparations for rapid cesarean section. 处理 Treatment 原则：止血补血，预防感染 方法；期待疗法 终止妊娠 孕37周以前或胎儿体重＜2300g . 患者状态良好，胎儿存活。 卧床休息. 间断吸氧,静脉高能营养促胎儿成熟. 抑制宫缩. Management Basic management Initial hospitalization with hemodynamic stabilization Enforced bed rest Restrictions of activity Expectant management (allow for further fetal growth and maturation) Blood transfusion is given as necessary Amniocentesis for fetal lung maturity testing Cesarean birth if fetus is thought to be mature Indication of vaginal delivery Delivery can be accomplished with minimal blood loss Fetus is dead Major fetal malformation Complication Placenta previa accreta Postpartum hemopphage Increasing maternal mortality and perinatal mortality 病因与预防 A.子宫体部内膜病变 B.胎盘面积过大 C.胎盘异常 D.受精卵滋养层发育迟缓 计划生育，防止宫内感染，减少内膜损伤。 产前宣教，及时就医， 早期诊断，正确处理。 * * * * * Bleeding is caused by seperation of part of the placenta from the lower uterine segment and cervix,possibly in response to mild uterine contractions. If the placenta lies in the posterior portion of the lower uterine segment,its exact relation with the internal os may be more difficult to ascertain. In these instances,transvaginal ultrasonography is useful adjunct to the transabdominal approach. * Before the widespread use of ultrasound, this procedure was done more frequently than it is in modern obstetrics. * * If the fetus is thought to be mature by gestational age criteria or by amniocentesis