Casepresentationplacentalabruption.pptVIP

Case presentation :  placental abruption by R2 王鎮華 故事敘述 背景 時間:民國93年12月08日凌晨 地點:五樓產房 現場實況 婦產科醫師的反應: 病人的情況: 我們對病人的準備狀況: 故事敘述 我的心情: 我的處置: 事情往後的發展: Patient profile 36 y/o ; female ; G1P0 ; GA :26weeks Hospitalization due to antepartum hemorrhage Preterm uterine contraction under Yutopar Event course Massive vaginal bleeding at 02:50 AM FHB 60/min. at 03:10 AM , then the patient was immediately sent to OR A baby was born at 03:37 Intubation at 03:45 ( Nimbex 10 mg , Fentanyl 100microgram) Blood gas : PH:7.35, HCO3:19.1,Ca:0.63, Hb:6.7,Hct:20 Event course Apgar score:0---5 Blood loss:1500ml U/O:200ml Transfusion:PRBC 4U,FFP 4U, PLT 12U Transferred to 4C1 at 04:50 ; H.R.:90, B.P.:187/111, O2 saturation:100 Event course Blood Gas: PH:7.48, PCO2:29.1, PaO2:360, HCO3:22.2, Hct:25, Hb:8.3, Electrolytes are all within normal range Transferred to 5B the next day Discharged on 12/13 Placental Abruption Definition : separation of the placenta from the decidua basalis before delivery of the fetus. Result : acute bleeding results from exposed decidual vessels. Fetal distress occurs because of loss of area for maternal-fetal gas exchange. Pathophysiology Major complications:hemorrhagic shock, acute renal failure (ARF), coagulopathy, fetal distress or demise. Major fetal risk:Hypoxia. Fetal oxygenation depends on adequate maternal oxygen-carrying capacity, uteroplacental blood flow, and transplacental exchange. Large maternal blood loss causes maternal hypotension, decreased uterine blood flow, and decreased maternal oxygen-carrying capacity. Abruption also causes a decrease in the placental surface available for exchange of oxygen. Pathophysiology A vicious cycle may be established in which a small placental abruption stimulates uterine contractions, causing further separation of the placenta. Respiratory distress syndrome is the most common neonatal complication; it occ