妇产科学-Postpartum Hemorrhage.pptVIP

Postpartum hemorrhage 韩立敏 Hanlm@zshospital.net Definition Hemorrhage (more than 500 ml) from the genital tract within 24 hours after delivery. Incidence: 2%─3%  Etiological factor Hypodynamic contraction of the uterus Tone placental factors Tissue The laceration of the soft birth canal Trauma coagulation disorders Thrombin psychentonia、 overdose of sedatives or/and narcotic weakness、combined with chronic diseases obstructive dystocia、prolonged labor various obstetric complications dysplasia of the uterus、grand multipara bigeminal、large for date infant、too much amniotic fluid hysteromyoma Placental factors retained placental tissue：Filling of bladder、placental incarceration、imcomplete placental separation placenta syncretio Placenta implantation retained placental or membranous tissue The tearing of soft birth canal the first degree of perineum tearing the second degree of perineum tearing the third degree of perineum tearing tearing vagina tearing of cervix the tearing of Lower uterine segment Causes for the tearing of the soft birth canal Too powerful labor、fast labor,precipitate labor justo major fetus、large for date infant Poor flexibility of the soft birth canal Unskilled vaginal productures Uncareful routine examination after parturition,incomplete suturation Coagulation disorders Obstetric complications:placental abruption、fetal death、amnionic fluid embolism、preeclampsia HELLP syndrome hematological disease:thrombocytopenia、aplastic anemia Severe liver diseases ：acute/chronic hepatitis,fatty liver Clinical manifestation Severe colporrhagia after fetal disengagement Often with symtoms of shock Clinical manifestation The features of poor uterine contraction： With symtoms of hypodynamia during delivery Can not touch the bottom of the uterus 、the contour of uterus is unclear intermittence bleeding、blood clot can be see