早孕胎盘绒毛植入教案.ppt

 妇科常见英语单词;;;病例二;;;;;病例三;;;病例四;;;病例特点一; 病历特点二;; 鉴别诊断;  宫腔镜检查(3月4日)： ;治疗经过;诊疗经过;介入治疗（入院第12天）;;;;;;;;;术后情况;问题;1.病理基础：子宫粘膜缺乏或缺陷 2.所有子宫内膜疾病都容易发生胎盘植入 3.粘膜下子宫肌瘤、子宫瘢痕、子宫肌瘤剔除术后或残角子宫切除术后及有刮宫、徒手剥离胎盘、子宫内膜炎病史;胎盘绒毛植入的临床特点 　　1.剖宫产史： 　　2.停经后阴道出血： 　　3.刮宫术时出现难以控制的大出血： 　　4.子宫穿破、腹腔内出血：; 　　1.子宫切除术 胎盘植入可发生致命性大出血，多需子宫切除术才能奏效 2.子宫动脉栓塞术; 早孕绒毛植入误诊1 例 吉林省临江林业局职工医院妇产科　宫　青 1　临床资料 ?? 一般情况: 患者, 女, 28 岁, 因停经45 d, 在当地卫生院行人工流产术后持续流血半个月, 又行消炎、促进宫缩、刮宫治疗, 观察1 周仍有阴道流血, 色暗, 又行第二次刮宫, 阴道持续流血1 个月, 不伴有腹痛, 术后HCG 定性持续阳性, 转入本院。发病以来无明显消瘦及咳嗽等症状。既往曾做过2 次人工流产, 足月分娩一胎。入院查体: 一般情况良好。妇科检查: 子宫增大约孕50 d 大小, 质软, 无明显结节及压痛。HCG 定量3 次分别为386、226 和202 IU ·L- 1 ( 正常值为120 IU·L- 1) 。彩色B 型超声: 子宫7. 3 cm×6. 4 cm× 5. 5 cm , 边界欠清, 中央有强光团, 附件正常。B 型超声: 人工流产不全, 绒毛膜癌待排出。遂入院后行清宫术, 术中探及宫腔8 cm, 宫腔壁无明显突起, 刮出少许组织物。病理报告: 增殖期子宫内膜。临床拟诊绒毛膜癌, 征得家属同意行手术治疗。剖腹探查术: 术中发现子宫增大约孕50 d 大小, 左宫角突起呈紫蓝色结节, 约5 cm×3 cm, 浆膜完整。双附件正常, 流血不明显, 切开紫色结节, 内部为均匀坏死织。行子宫次全切除加左附件切除术。病理报告: 左宫角绒毛植入。术后8 d 痊愈出院。;;Int J Crit Illn Inj Sci.?2013 Jul;3(3):183-9. doi: 10.4103/2229-5151.119197. Contemporary issues in the management of abnormal placentation during?pregnancy?in developing nations: An Indian perspective. Bajwa SK1,?Singh A1,?Bajwa SJ2. Abstract The gap between the developed and developing nations with regards to maternal mortality and morbidity may have narrowed but still a lot of dedicated work is required to bridge these differences. Obstetrical haemorrhage is the leading cause of maternal deaths in these developing nations especially in India. The most common causes of this fatal haemorrhage are the placental abnormalities which rarely get detected before delivery. Numerous factors have been incremental in the causation of this abnormal placental?implantation?with resultant complications. The present article is an attempt to review possible predictors of abnormal placental?implantation. Also, a genuine attempt has been made to enumerate possible measures to identify the predictors of abnormal placentation during?early