产科学英文课件：13 Placental Abruption.ppt

Placental Abruption General Consideration Definition separation of the normally located placenta after the 20th gestational week and prior to birth. Incidence 0.51%-2.33% (our country) 0.5% (other countries) Incidence of fetal death 200‰-350‰ The most important cause of vaginal bleeding in late pregnancy Cause of bleeding proportion Placental Abruption 31.7% Placenta previa 12% Lesion of cervix 7% Factors of Cord 1% No cause 40% Severe complication of pregnancy Causes of hemorrhage Number (%) Placental Abruption 141(19) Laceration/uterine rupture 125(16) Uterine atony 115(15) Coagulopathies 108(14) Placenta previa 50(7) Placenta accreta/increta/percreta 44(6) Uterine bleeding 47(6) Retained placenta 32(4) Causes of 763 pregnancy-related deaths due to hemorrhage 1999 Etiology Uncertain (primary cause) Risk factors Vascular diseases: preeclampsia, chronic hypertension, renal disease. Mechanical factors: abdomen strick, intercourse, extreme shortness of umbilical cord（脐带过短）amniocentesis （羊膜穿刺术） uterine volume suddenly narrow and uterine cavity pressure drop ：rupture of membrane when polyhydramnios（羊水过多） Increased age and parity Sudden increase in uterine venous pressure：Supine hypotensive syndrome（仰卧位低血压） other：Smoking, cocaine use, uterine myoma，Race Pathology Main change hemorrhage into the decidua basalis → decidua splits → decidual hematoma → separation, compression, destruction of the placenta adjacent to it Types revealed abruption concealed abruption, mixed type Uteroplacental apoplexy 子宫胎盘卒中 Types revealed abruption concealed abruption mixed type Uteroplacental apoplexy Bleeding into the myometrium of the uterus giving a discolored appearance to the uterine surface. Adjunctive Examination Ultrasonography Position of placenta, severity of abruption, survival of fetus Signs: retroplacental hematoma Negative findings do not exclude placental abruption Laboratory examination consumptive coagulopathy: Rt, DIC Function