妇产科学-Placental Abruption.pptVIP

Question 1. Differential diagnosis of placenta previa and placenta abruption. 2. Treatment of placenta abruption. * Placental Abruption Obstetrics Gynecology Hospital of Fudan University Yan Pin Xia Definition The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. 1、Vascular diseases 2、 Mechanical factors 3、Uterine vein pressure increase suddenly 4、Others Etiology Classification Concealed separation Apparent separation Mixed separation Revealed Abruption The blood drains through the cervix, placental detachment is more likely to be incomplete. Concealed Abruption The hemorrhage is confined within the uterine cavity, detachment of the placenta may be complete. Mixed Hemorrhage Progressive hemorrhage drains through the cervix. Uteroplacental apoplexy  Concealed Hemorrhage Hemorrhage infiltrates the Uterine wall Local press Extensive intramyometrial bleeding A purplish and copper-colored, ecchymotic, indurated Uterus. Tissue thrombogen released Maternal clotting system actived DIC Defibrination system actived Depletion of fibrinogen ,platelet… Clotting deficiency One mechanism is local vascular injury that results in vascular rupture into the decidua basalis, bleeding and hematoma formation. Pathology 出血增多 底蜕膜 出血 胎盘后 血肿 胎盘自附着处剥离 血肿冲开胎盘边缘 剥离面释放大量组织凝血因子(III因子) III因子进入母体循环 激活凝血系统 DIC 肺、肾等器官内Cap微血栓 纤溶系统激活 纤维蛋白原分解 抗凝作用、 干扰凝血酶/纤微蛋白原反应 纤微蛋白多聚作用 抑制血小板功能 FDP增加 凝血因子耗竭 剥离面小，出血止 临床无症状 纤微蛋白原耗竭 子宫胎盘卒中 子宫胎盘卒中 Clinical findings Less severe severe types 外出血（显性） 内出血（隐性） detachment 剥离面积1/3 剥离面积1/3 Onset time 多见于分娩期 多见于妊娠期 symptom 阴道出血 腹痛 Anemia, shock 与出血量相当 与出血量不符 Uterine irritability 软、宫缩有间隙 硬，板状，无间隙 Uterine size 与孕周相符 与孕周不符 Abdomial pain 局部压痛 全子宫压痛，胎盘附着处明显；若后壁胎盘，压痛不明显 Fetal position 能查清 触诊不清 Fetal State 多正常 剥离面积1/2，胎儿出血多、贫血、死胎 Postpartum examination 胎盘后血肿面积小 胎盘后血肿面积大 ? 1. Ultrasound Adjunctive Examination Fetal heart rate tracing from