中期引产产后出血（Mid-term induction of labor; postpartum hemorrhage）.docVIP

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中期引产产后出血（Mid-term induction of labor; postpartum hemorrhage）.doc

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中期引产产后出血（Mid-term induction of labor; postpartum hemorrhage）

中期引产产后出血（Mid-term induction of labor; postpartum hemorrhage） Rescue of hemorrhagic shock induced by induction of labor in second trimester Postpartum hemorrhage is greater than 300ml. It is called bleeding after induction of labor Reason： 1) placental factors (implantation, retention, placental remnants) 2) soft birth canal injury (laceration of vagina and cervix, hematoma of reproductive tract and rupture of uterus) Hemorrhagic shock Traditional diagnosis is based on history, symptoms and signs Changes in mental status, clammy skin Heart rate is greater than 100/min, urine volume is less than 0.5ml/kg.h Decreased systolic blood pressure (90mmHg or lower baseline blood pressure, 40mmHg or pulse pressure reduction, 20mmHg CVP5mmHg or pulmonary artery wedge pressure 8mmHg Recent research findings Oxygen metabolism and tissue perfusion index have important reference value for early diagnosis of hemorrhagic shock Blood lactate and basal deletion are also important in surveillance and prognosis of shock. Grading of hemorrhagic shock Stage I (pre shock stage): blood loss (750ml), percentage of blood volume, 15% Stage II (mild shock): blood loss, 750ml~1500, ML, the proportion of blood volume, 15%~30% Stage III (moderate shock): blood loss 1500~2000, ML, the proportion of blood volume, 30%~40% Class IV (severe shock): blood loss 2000 ml, accounting for the proportion of blood volume 40% Shock index = pulse rate / systolic blood pressure Pulse rate / systolic blood pressure (mmHg), shock index, blood loss 70/140 (normal) (18.67KPa) 0.5 100/100 (13.337KPa) 1 1000~1500 (20%-30%) 120/80 (10.66KPa) 1.5 1500~2500 (30%-50%) 140/70 (9.33KPa) 2 2500~3500 (50%-70%) Massive blood loss is defined as an estimated blood volume within 24h of blood loss over patients Or 3h, more than half of the blood volume was estimated Shock degree and clinical manifestation The degree of shock pulse rate (BPM) systolic blood pressure (mmHg) the amount of urine and other symptoms A mild change in the a