妇产科学教学（重庆医科大学）6.2胎盘早剥.pptVIP

? * * * * * * * * * * * * * * * * A 30 yr-old pregnancy woman at 31 weeks is admitted to the obstetric ward after a motor-vehicle accident. She complains of sudden onset of vaginal bleeding for the past hour. She has intense, constant uterine pain and frequent uterine contractions and abdominal tenderness. Fetal heart tones are regular at 135/min. Case Placenta Abruption  Luo Xin MD Dept. of Obstetrics The 1st Affiliated Hospital of CQMU E-mail: luoxin.cqmu@ Etiology Pathology Complications Definition 1 Management Catalog 2 3 4 5 6 Classification Clinical manifestation Diagnosis Differential diagnosis Definition Placenta abruption : After 20 gestational weeks, the normally implanted placental separation from its implantation site before delivery. ≥20W The normally implanted placenta ！ Etiology Maternal vascular diseases Mechanical factors Uterine venous pressure rose suddenly Advanced age, Smoking, cocaine abuse and others Maternal vascular diseases PIH (Pregnancy induced hypertention) Chronic kidney disease Spasm of spiral arteries caused capillaries rupture in decidua basalis.(螺旋动脉痉挛导致的底蜕膜毛细血管破裂) Mechanical factors Trauma Sex at late pregnancy Amniocentesis （羊膜腔穿刺术） Uterine volume decreased suddenly Uterine venous pressure ↑ Enlarged uterus result in an elevated compression and venous pressure Decidua vein congestion and rupture Supine hypotensive syndrome (仰卧位低血压综合征) Pathology Placental separation is initiated by hemorrhage into the decidua basalis with formation of a decidual hematoma. Uteroplacental apoplexy Pressure of hematoma increased. Blood invade into the uterus myometrium. Muscle fibers separated, even broken. Uterine surface turned purple blue . Pathology Severe placental abruption Release of thrombokinase 凝血活酶 Coagulation system Activating Consume maternal coagulation substance disseminated intravascular coagulation (DIC) P