产后出血八年制.pptxVIP

第1页/共23页产后出血八年制第2页/共23页Definition A blood loss of 500 ml or more in the first 24 hours after deliveryA description, not a diagnosisThe primary cause of maternal mortality第3页/共23页Predisposing factors and causesUterine atonyPlacenta abnormityTrauma to the genital tractCoagulation defects第4页/共23页1. Uterine Atony (子宫收缩乏力)Obstetric factorProlonged labor 滞产Precipitate delivery (delivery 3 hrs) 急产Pregnant complications placenta previa placental abruption chorioamnionitis(绒毛膜羊膜炎)Oxytocin-induced labor引产Augmented labor 催产第5页/共23页1. Uterine Atony (子宫收缩乏力)Systemic factorPsychological factorsTocolytic agent 宫缩抑制剂Conduction analgesia(镇痛分娩)Uterus factorOverdistended uterus: large fetus, twins, hydramniosUterus myoma, history of CS, myomectomyHigh parity第6页/共23页IncidenceIncidence of PPHPPH of Uterine Atony 第7页/共23页2. Placental factorsRetained placental tissuePlacentaSuccentuiate lobe (副叶胎盘)Embryolema (胎膜)Abnormally adherentAccreta, increta, percreta (粘连，植入，穿透)第8页/共23页3. Trauma to the genital tractCausesPrecipitate delivery急产, large fetusUnthorough Hemostasis (止血)Laceration of perineum, vagina, cervixUterine RuptureHaematomas第9页/共23页4. Coagulation defectsPregnant complicationsAmniotic fluid embolism (AFE, 羊水栓塞)Hypertensive disorders in pregnancyPlacental abruption Still birthHaematological diseasesIdiopathic thrombocytopenic (ITP, 特发性血小板减少性紫癜),Aplastic anemia (AA, 再生障碍性贫血)第10页/共23页Clinical manifestationVaginal bleeding出血发生时间有无凝血块血肿？Symptoms of shock第11页/共23页DiagnosisEstimating blood lossVisual estimation Objective measurement称重法面积法 10cm*10cm=10mlShock index HR/SBP=0.5 normal 1.0 blood loss 20~30% 1.5 blood loss 30~50% 2.0 blood loss 50% 第12页/共23页DiagnosisCause analysisUterine Atony: a soft, boggy uterus 正常胎儿娩出后宫底位置？Placental factors 正常胎盘娩出时间？ 如何检查？ 第13页/共23页DiagnosisCause analysisTraumaPerineal lacerationVaginal laceration, hematomaCervical traumaCoagulation disordersHistoryLab test第14页/共23页ManagementOrganization of the multidisciplinary team 组织抢救Restoratio