第四章 产后出血(postpartum hemorrhage).pptVIP

教学内容 胎儿窘迫、子宫破裂、产后出血 ——约2学时 脐带异常 、羊水量异常、早产、胎膜早破、过期妊娠、多胎妊娠 ——约1学时＋自学 王正平 浙江大学医学院附属妇产科医院 产科 Tel2061 Post Partum Hemorrhage Uterine Rupture, Fetal Distress Women Hospital , School of Medical, ZheJiang University Wang Zheng Ping Post partum hemorrhage Post partum hemorrhage Past partum hemorrhage denotes excessive bleeding (≥500ml in vaginal delivery) during the first 24 hours after delivery Common cause of death and diseases in pregnant women globally Leading cause of death in pregnant women in China Incidence 2%-3% of total number of deliveries Etiology Uterine atony: 70% Obstetric lacerations: 20% Retained placental tissue: 10% Coagulation:1% Uterine atony General factors: extreme nervousness, sedative, anesthesia, tocolytics, weak Obstetric factors: prolonged labour, fatigue, placenta previa, placenta abruptio, severe anemia Uterine factors: uterine muscular fiber underdevelopment, such as uterine deformity or myoma; uterine overstretched, such as macrosomia, multiple pregnancy, polyhydramnios Placental factors Incomplete placental separation Retained placenta Placental incarceration（嵌顿 ） Placental adhesion Placental implantation (accreta, increta, percreta) Residual placenta and amniotic membrane Birth canal injury Laceration during labour are usually associated with: Poor vulval elasticity Strong labour force, emergency delivery, macrosomia Inadequate skills at assisted vaginal delivery Inadequate cessation of bleeding during episiotomy repair, missing out tears at cervix or fornices Coagulation disorder Complications associated with obstetric: amniotic fluid embolism, pregnancy induced hypertensive diseases, placenta abruptio and intrauterine demise Pregnancy liver disease: acute fatty liver, severe hepatitis Hematology diseases: primary thrombocytopenic purpura, aplastic anemia etc Clinical presentation Vaginal bleeding: If bleeding occurs immedia