子宫破裂精品课件

子子 宫宫 破破 裂裂 汕头大学医学院第一附属医 院 郑丽璇 定义 原因 分类 临床表现 诊断 鉴别诊断 处理 预防 一、定义 子宫体部或子宫 下段与妊娠晚期 或分娩期发生的 子宫破裂。 二、原因 胎先露下降受阻 子宫疤痕 手术创伤 子宫收缩剂 使用不当 三、分类 原因：自发性 损伤性 时间：妊娠期 分娩期 程度：完全 不完全 部位：子宫体部 子宫下段 四 临床表现 先兆子宫破裂 子宫破裂 一）先兆子宫破裂 症状：下腹剧痛难忍、 烦躁不安、呼叫； 体症：病理缩复环 子宫下段膨隆、压痛明显 可触及子宫圆韧带、有压痛 排尿困难、血尿 胎心率改变或听不清 二）子宫破裂 1、完全性子宫破裂 症状：突感撕裂样腹部剧痛、腹痛骤减、 呈持续续性，休克 体症：休克表现 全腹有压压痛及反跳痛 在腹壁下可扪扪及胎体，胎心消失 缩缩小宫宫体位于胎儿侧侧方 阴道可能有鲜鲜血流出，量可多 可少 2、不完全性子宫破裂 症状：下腹疼痛 烦烦躁不安 体症：在子宫不全破裂处有明显压痛 如形成阔韧带阔韧带 血肿肿，可在宫宫体 一侧扪侧扪 及逐渐渐增大、有压压痛的 包块块,胎心多不规则规则 病理缩复环病理缩复环 五、诊断 (diagnosis) 临床表现 B型超声检查 六、鉴别诊断 （differential diagnosis） 重型胎盘早剥：病史：妊高征、外伤 体征：子宫板样硬 B超：胎盘后血肿 胎儿在宫腔内 宫腔内感染：病史：胎膜早破 体征：T、胎儿在宫腔内 化验：WBC、N 七、处理（management) 先兆子宫破裂：抑制宫缩（静脉全麻） 尽快行剖宫产术 子宫破裂：抢救休克 同时手术:子宫次全切术 子宫全切术 修补术 八、预防 (prevention) 加强围生期保健，做好产前检查 有高危因素者，应在预产期前1-2周入院待产 提高观察产程能力，及时发现异常、及时处理 （子宫有瘢痕、畸形、先露高、胎位异常） 严格掌握缩宫素引产指征 严格掌握剖宫产、阴道助产指征，按常规进行 （中高位产钳、内倒转术、人工剥离胎盘） 忽略性横位 手取胎盘 产钳术 忽略性横位 手取胎盘 产钳术 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