产后出血-熊钰.ppt

In order to control bleeding quickly, subtotal hysterectomy can gain time. But if uterine atony caused by placenta previa, total hysterectomy maybe optimal choice. Arterial embolization is another choice to treat PPH A patient with stable vital signs and persistent bleeding, especially if the rate of loss is not excessive, may be a candidate for arterial embolization. Embolization can be used for bleeding that continues after hysterectomy or can be used as an alternative to hysterectomy to preserve fertility. Radiographic identification of bleeding vessels allows embolization with Gelfoam, coils, or glue. Balloon occlusion is also a technique used in such circumstances. Now we summarize the treatment of atony PPH. An algorithm has been suggested by FIGO for the management of atonic PPH. It is called H.A.E.M.O.S.T.A.S.I.S. The possibility that additional products of conception remain within the uterine cavity should be considered. Ultrasonography can help diagnose a retained placenta. Retained placental tissue is unlikely when ultrasonography reveals a normal endometrial stripe. Although ultrasonographic images of retained placental tissue are inconsistent, detection of an echogenic mass in the uterus is more conclusive. Ultrasound evaluation for retained tissue should be performed before uterine instrumentation is undertaken (9). Spontaneous expulsion of the placenta, apparent structural integrity on inspection, and the lack of a history of previous uterine surgery (suggesting an increased risk of abnormal placentation) make a diagnosis of retained products of the placenta less likely, but a curettage may identify a succenturiate lobe of the placenta or additional placental tissue. When a retained placenta is identified, a large, blunt instrument, such as a banjo curette or ring forceps, guided by ultrasonography, makes removal of the retained tissue easier and reduces the risk of perforation. The extent (area, depth) of the abnormal attachment will determine