LatePregnancyBleeding晚期妊娠流血.pptxVIP

会计学1LatePregnancyBleeding晚期妊娠流血 第1页/共28页 ImportanceMaternal RisksAcute hemorrhageOperative deliveryFetal RisksUteroplacental insufficiencyPremature birthKey PointsIdentify the causeTimely intervention第2页/共28页 Initial AssessmentHistoryAmount of bleeding, recent intercourse or digital exam, severity of pain, traumaPhysical examVital signs, speculum, digital only if no placenta previa, may note cervicitis/ polyp/cancerUltrasoundEvaluation for placenta previaPeriod of observation第3页/共28页 Initial Management of Significant BleedingHemodynamic instabilityHypotensionTachycardiaIV fluidsConsider blood products/transfusionLab testsHematocrit, platelets, fibrinogen, coagulation, blood type, and antibody screenContinuous fetal monitoringConsider emergent cesarean section第4页/共28页 Placenta PreviaCompleteCovers the internal cervical osMarginalEdge lies within 2cm of internal cervical osLow lyingEdge lies 2 – 3.5cm from the internal os第5页/共28页 第6页/共28页 Placenta Previa (continued)Noted in mid-pregnancy in 40/1000 pregnanciesAt term, only 4/1000Best visualized with transvaginal ultrasoundRisk factorsIncreased ageIncreased parityTobacco useIncreasing number of cesarean deliveries第7页/共28页 Placenta Previa (continued)Presentation“painless bleeding”Often “sentinel bleed” in the late 2nd or early 3rd trimesterOften after sexual intercourse第8页/共28页 Placenta Previa (continued)ManagementGoal is to promote fetal lung maturityAdmit to hospital initiallyAdminister steroids if 24-34 weeks gestationConsider tocolyticsOutpatient management in selected situationsSerial ultrasoundsIf does not resolve, cesarean delivery at term第9页/共28页 Placenta Previa (continued)Mode of deliveryIf unstable, immediate cesarean deliveryIf stable, ultrasound at 36 weeksIf placental edge 2cm from os, vaginal deliveryIf placental edge 1-2cm from os, may attempt vaginal delivery if operating room near byIf fetal lungs are mature, cesarean for complete previaIf history of cesarean, evaluate for invasive placentaColor flow D