Births Obstetric Emergencies高风险出生产科急症ppt课件.pptVIP

* * * Influencing factors having to do with the Mom: Operative birth Precipitate birth Congenital abnormalities of the maternal soft parts Contracted pelvis Previous scarring from infection, injury or operation Vulvar, perineal, and vaginal varicosities also can cause lacerations Pelvic hematomas can be vulvar, vagtinal or retroperitoneal in origin. Vulvar hematomas are the most common, and generally the most visible. Cervical lacerations usually occur at the lateral angles of the external os. Most are shallow, and bleeding is minimal. More extensive lacerations may extend into the vaginal vault or into the lower uterine segment. Influencing factors having to do with the baby: Size Abnormal presentation Position of the fetus * Placental retention because of poor separation is common in very preterm births (20 to 24 weeks gestation). NONADHERENT RETAINED PLACENTA Management: manual separation and removal of placenta Don’t usually need supplemental anesthesia if woman has had regional anesthesia After removal woman is still at risk for severe PPH and infection ADHERENT RETAINED PLACENTA Abnormal adherence of the placenta Cause unknown. Placenta adheres to an area of defective endometrium so that there is no separation between placenta and the decidua. Attempts to remove are usually unsuccessful. Laceration or perforation of the uterine wall may result. Risk for severe PPH and infection. Can be partal or complete. Treatment may include blood replacement and hysterectomy. Degrees of attachement: Placenta accreta = slight penetration of myometrium by placental trophoblast Placenta increta = deep penetration of myometrium by placenta Placenta percreta = perforation of uterus by placenta. * Most often occurs in multiparous women and with placenta accreta or increta. Presenting signs: Hemorrhage Shock pain * * Palpation of pulses: Arterial Blood pressure Auscultation: Heart sounds and murmurs Breath sounds Inspection: Skin color, temperature, turgor Level