胎盘早剥英文课件.ppt

Placenta abruptio Alternative names??? Return to top Premature separation of placenta; Accidental hemorrhage; Ablatio placentae; Abruptio placentae; Placental abruption Definition??? (after the 20th week or during delivery)The separation of the placenta(in normal site) from the site of uterine implantation before delivery of the fetus. Causes??? Direct causes (1 to 5%).? mechanical factors such as abdominal trauma (for example, from an auto accident or fall) sudden loss in uterine volume ( rapid loss of amniotic fluid or the delivery of a first twin0 abnormally short umbilical cord (usually only a problem at the time of delivery). Predisposing factors ? a past medical history of placenta abruptio (after 1 prior episode there is a 10 to 17% recurrence, after 2 prior episodes the incidence of recurrence exceeds 20%) hypertension or high blood pressure during pregnancy is associated with 2.5 to 17.9% incidence (however, approximately 50% of placenta abruptio cases severe enough to cause fetal death are associated with hypertension) increased maternal age increased number of prior deliveries increased uterine distention (as may occur with multiple pregnancies or abnormally large volume of amniotic fluid) diabetes mellitus in the pregnant woman cigarette smoking; cocaine abuse; and drinking alcohol during pregnancy (more than 14 drinks per week). Incidence The incidence of placenta abruptio, including any amount of placental separation prior to delivery, is about 1 out of 150 deliveries. However, the severe form (resulting in fetal death) occurs only in about 1 out of 500 to 750 deliveries Pathologic changes Revealed abruption Concealed abruption Mixed type Bloody emniotic fliud Uteroplacental apoplexy DIC classification Mild type Severe type 1/3 Clinical findings Symptoms??? Vaginal bleeding Abdominal pain Back pain Signs and tests??? Physical examination reveals uterine tenderness and/or increased uterine tone. Hemorrhage or heavy bleeding in preg