胎盘的早期剥离.pptVIP

Placental Abruption Zongjun Hao Department of Ob Gy Taian public Health School of Shandong Province General Consideration perinatal morbidity发病率 0.46%-2.1% (our country) 1% (other countries） perinatal mortality死亡率 20%-35% Etiology 病因 Risk factors 1、Vascular diseases: 血管疾病 preeclampsia, chronic hypertension, renal disease. 先兆子痫、慢性高血压、慢性肾病等 2、Mechanical factors: 机械性损伤 trauma, intercourse etc. 外伤 、性生活 、外倒转术纠正胎位等 Etiology 病因 Risk factors 3、Supine hypotensive syndrome 仰卧位低血压综合征 4、reducing of uterine presure suddenly 宫腔内压力骤降 multiple gestaion, hytramnios etc. 5、others:其它 short umbilical cord etc. 脐带过短、绕颈等 Pathology Main change 主要病理改变 hemorrhage of the decidua basalis 底蜕膜出血 Pathology change Pathology Clinical chracteristics Sudden ， continuous abdominal pain 突然的、持续的腹痛 Complication并发症 Uteroplacental apoplexy 子宫胎盘卒中 Hypovolemic shock 低血容量性休克 Amniotic fluid embolism 羊水栓塞 Acute renal failure 急性肾功能衰竭 Postpartum hemorrhage 产后出血 DIC 弥漫性血管内凝血 Treatment Treatment of hypovolemic shock: 抗休克 intensive transfusion with blood  Pathology 1 Pathology 2 Pathology 3 * * 胎盘早期剥离 孕妇，30岁，G1P0 ，36周妊娠，2h前腹部受外伤后出现持续性腹痛而入院。检查：孕妇面色苍白，血压60/40 mmHg，胎心率100次/min，子宫底位于剑突下2横 指，子宫压痛，张力高。正确处理方法为： A、给予镇静止痛剂 B、纠正休克后继续妊娠 C、纠正休克，同时行剖宫产术 D、应用子宫收缩抑制剂 病例 C 难点 Difficult points Pathology of placental abruption. 胎盘早剥的病理 Etiology 、 Clinical chracateristic and Treatment病因和治疗原则 重 点 emphasis 学习目标 sdudying Aims Grasp the definition 、 Etiology 、 Pathology 、Clinical chracateristic and priciples of placental abruption. 掌握胎盘早剥的定义、 发病原因、 病理及其临床特点和治疗原则 Definition 定义 The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. 妊娠20周后或在分娩期发生正常位置的胎盘发生部分或全部从子宫壁剥离。 hemorrhag