产后出血(英文) ppt课件

Postpartum Hemorrhage,Union Hospital,Definition,Postpartum hemorrhage denotes excessive bleeding (500mL in vaginal delivery) following delivery.,Incidence,58%Postpartum hemorrhage is the most common cause of excessive blood loss in pregnancy.,Etiology,Uterine atonyObstetric lacerationsRetained placental tissueCoagulation deffects,Uterine atony,Uterine atony exists when the myometrium cannot contractAtony is the most common cause of postpartum hemorrhage (50% of cases),excessive manipulation of the uterusgeneral anesthesiauterine overdistentionprolonged laboruterine leiomyomas.,Obstetric lacerations,Uteruscervixvaginavulvahematomas,Retained placental tissue,Placenta accretain manual removal of the placentain mismanagement of the third stage of laborin unrecognized succenturiate placenta,Coagulation deffects,Abruptio placentaeexcess thromboplastin from a retained dead fetusamniotic fluid embolismsevere preeclampsiaeclampsiasepsis,Prevention,Predelivery preparationdelivery third stage of normal labor (placenta separation),Evaluation of persistent bleeding,Manually compress the uterusobtain assistanceif not already done, obtain blood for typing and cross-matchingobserve blood for clotting to rule out coagulopathycarefully explore the uterine cavity,Measures to control bleeding,Manual exploration of the uterusBimanual compression curettageOxytocinRadiographic embolization of pelvic vesselsOperative management,Operative management,Pressure occlusion of the aortaUterine artery ligationInternal iliac artery ligationB-lynch brace sutureHysterectomy,Postpartum puerperium infections,Definition,Puerperal morbidity due to infection has occurred if the patients temperature is higher than 380C on 2 separate occasions at least 24 hours apart following the first 24 hours after delivery.,Incidence,2-8%undergone operative deliverypremature rupture of the membraneslong laborsmultiple pelvic examinations,Morbidity and motality,Contribute to the death of about 8% of all pregnant women who die each year.,Pathogenesis,Aerobic bacteriaAnaerobic bacteriaMycoplasmaUreaplasma,Mechanisms to prevent overt infection,Acidity of the normal vaginathick, tenacious cervical mucusmaternal antibodies to most vaginal flora,Etiology,Cesarean sectionundergone operative deliverypremature rupture of the membraneslong laborsmultiple pelvic examinations,Clinical findings,EndometritisUrinary tract infectionGeneralized sepsisseptic pelvic thrombophlebitispelvic abscess,Symptoms and signs,FeverUterine tenderness,Laboratory findings,Leukocytosisurinalysisbacterilogic findings (Aerobic bacteria, Anaerobic bacteria, Mycoplasma, Ureapl