第12章 胎盘早剥 与 前置胎盘课件.pptVIP

General Consideration Definition The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. Frequency 0.46%-2.1% (our country) 1%-2% (other countries) Incidence of fetal death 200‰-350‰ Pathology Main change hemorrhage into the decidua basalis → decidua splits → decidural hematoma → separation, compression, destruction of the placenta adjacent to it Types revealed abruption, concealed abruption, mixed type Uteroplacental apoplexy 子宫胎盘卒中 Diagnosis sign and symptom Vaginal bleeding Uterine tenderness or back pain Fetal distress High frequency contractions Hypertonus Idiopathic preterm labor Dead fetus Diagnosis Ultrasonography Differential diagnosis Placenta previa Painless bleeding Pre-rupture of uterus dystocia Treatment Treatment will vary depending upon gestational age and the status of mother and fetus Treatment of hypovolemic shock: intensive transfusion with blood Assessment of fetus Termination of pregnancy: CS or Vaginal delivery Treatment Treatment of consumptive coagulopathy Supplement of coagulation factors: fresh blood, frozen blood plasma, fibrinogen, blood platelet. Heparin: high coagulation Anti-fibrinolysis Prevention of renal failure 假如你是大夫... 例:孕37周阴道三次较多量无痛性出血,来诊? 例:孕30周+4天 ,曾阴道无痛出血两次,咨询? PLACENTA PREVIA 前 置 胎 盘 正常胎盘附着位置 定义 (Definition) 妊娠28周后，胎盘附着于子宫下段，甚至胎盘下缘达到或覆盖宫颈内口，其位置低于胎儿先露部，称为前置胎盘 分类 (Classification) Classification 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 处理 Treatment 原则：止血补血，预防感染 方法；期待疗法 终止妊娠 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 diagnosis Painless vaginal bleed: first bleeding episode is 29~30 weeks Ultrasonography: benefit in localizing the placenta and diagnosis placenta previa 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 an