产后出血 PPT课件.pptVIP

失血原因诊断 宫缩乏力： 阴道流血增多，宫底升高，子宫质软，按摩子宫或使用宫缩剂后子宫变硬，阴道流血减少或停止。 胎盘因素： 胎儿娩出后10分钟内，胎盘未娩出，阴道大量流血，应考虑胎盘因素，胎盘残留是引起产后出血的常见原因，娩出后常规检查胎盘胎膜是否残留，注意副胎盘残留。 软产道裂伤： 胎儿娩出后即出现阴道大量流血，鲜红, 疑有软产道裂伤时应及时仔细检查软产道。 包括：宫颈裂伤、阴道裂伤、会阴裂伤 失血原因诊断 会阴裂伤分4度 Ⅰ度—会阴皮肤及阴道入口粘膜撕裂，出血不多。 Ⅱ度—裂伤达会阴体筋膜及肌层，累及阴道后壁粘膜， 甚至阴道后壁两侧沟向上撕裂。 Ⅲ度—肛门外括约肌已断裂，直肠粘膜完整。 Ⅳ度—肛门、直肠和阴道完全贯通，直肠 腔外露，组织严重损伤 持续阴道流血，出血不凝，止血困难，全身多部位出血； 血小板计数，纤维蛋白原、凝血酶原时间等检查异常。 凝血功能障碍 Management Principal of management for PPH Rapid hemostasis according to the cause Replenish volume, correct shock Prevent infection Management of uterine atony Uterine massage: Abdominal fundus massage Abdominal-vaginal bimanual uterine massage Uterotonic agents: oxytocin/prostaglandins Uterine packing Pelvis vessel ligation B-Lynch suture Arterial embolism Hysterectomy Uterine packing uterine artery ligation B-Lynch suture Arterial embolism Management of placental factors Retained placenta – remove separated placenta quickly Residual placenta or membrane – curettage Placental adhesion – manual removal of placenta Placental implantation – never separate forcefully, usually hysterectomy Management of laceration Thorough hemostasis Stitch according to anatomical layering First stitch must be 0.5cm above top end When stitching do not leave dead space Avoid stitching through rectal mucosa Manage cervical tear Manage birth canal hematoma Manage cervical tear Management of coagulation disorder First exclude bleeding caused by uterine atony, placental factors and birth canal injury Actively transfuse fresh whole blood, platelets, fibrinogen or prothrombin complex, clotting factors etc If DIC set in, manage DIC 失血休克的处理 1、正确估计失血量，判断休克程度 2、建立静脉通道，中心静脉压监测，晶 体、冰冻血浆 3、升压药物 4、给氧、纠酸 5、防治肾衰 6、保护心脏 7、预防感染 预 防 1、产前预防 2、产时预防 3、产后预防 产 后 出 血postpartum hemorrhage 内 容 概念 (Definition) 病因 (Etiology) 临床表现 (Clinical manifestation) 诊断 (Diagnosis) 处理（Management) 预防（Prophylaxis ） Def