(妇产科学课件）8.4（参考翻译）Placental Abruption

1、( (妇产科学课件）妇产科学课件）8.48.4（参考翻译）（参考翻译）Placental Placental AbruptionAbruption A common predisposing factor 诱因诱因 is previous placental abruption. Following one episode 段段, the rate of recurrence 再发再发 is 10% 17%. Following 2 episodes 段段, the rate of recurrence 再发再发生率生率 exceeds 超过超过 20%.Etiology 病因病因Etiolo

2、gy 病因病因 Hypertension in pregnancy 妊娠期高血压妊娠期高血压 (preeclampsia 子痫前期子痫前期) Chronic hypertension 慢性高血压慢性高血压 Chronic kidney disease 慢性肾脏病慢性肾脏病Spasm of spiral arteries 螺旋动脉痉挛螺旋动脉痉挛 caused capillaries rupture 毛细血管破裂毛细血管破裂 in decidua basalis 底蜕膜底蜕膜.Etiology 病因病因Etiology 病因病因Etiology 病因病因Pathology 病理病理Retropl

3、acental hematoma 胎盘后血肿胎盘后血肿Pathology classification 病理分类病理分类 Revealed abruption 显性剥离显性剥离 Concealed abruption 隐性剥离隐性剥离 Mixed bleeding 混合型出血混合型出血Revealed abruptionConcealed abruptionMixed bleedingPathology classification 病理分类病理分类Revealed abruptionConcealed abruptionMixed bleedingPathology classificati

4、on 病理分类病理分类 1. Revealed abruption 显性剥离 Bleeding extends toward cervix 宫颈宫颈, leading to external 表面的表面的 or visible 可见的可见的 bleeding.2. Concealed abruption 隐性剥离隐性剥离 Bleeding stays between placenta and uterine wall 子宫壁子宫壁, can not flow out, resulting in internal hemorrhage 内出血内出血. Fundus of Uterus rises

5、. 子宫底抬高子宫底抬高Pathology classification 病理分类病理分类Retroplacental hematoma 胎盘后血胎盘后血肿肿Pathology classification 病理分类病理分类3. Mixed bleeding 混合型出血混合型出血(mixed abruption 混合性剥离混合性剥离)Revealed bleeding 显性流血显性流血+Concealed bleeding 隐性流血隐性流血Pathophysiology 病理生理病理生理1.Uteroplacental apoplexy 子宫胎子宫胎盘卒中盘卒中 Pressure of hem

6、atoma 血肿血肿 increased. Blood invaded into 侵入侵入 the myometrium 子宫肌层子宫肌层. Muscle fibers 肌纤维肌纤维 were separated from each other, even broken. Serous membrane 浆膜浆膜 turned blue and dark.Uteroplacental apoplexy 子宫胎盘卒中子宫胎盘卒中子宫胎盘卒中Uteroplacental apoplexy子宫胎盘卒中子宫胎盘卒中Uteroplacental apoplexy 子宫胎盘卒中子宫胎盘卒中Pathophy

7、siology 病理生理病理生理2.Coagulation disorders 凝血功能紊乱凝血功能紊乱Placental abruptionRelease of thrombokinase 凝血活酶凝血活酶 Activate coagulation systemConsume maternal coagulation substance 消耗母体凝血物质消耗母体凝血物质disseminated intravascular coagulation(DIC)Clinical manifestation 临床表现临床表现 Sudden, acute abdominal pain. 突然、急剧的腹痛

8、突然、急剧的腹痛 Vaginal bleeding in third trimester. 妊娠晚期阴道流血妊娠晚期阴道流血CHARACTER of bleeding Painful尺寸1/2类型显性显性/隐性隐性/混合性症状无腹痛轻度流血无贫血突发疼痛阴道流血、贫血表现各异突发疼痛阴道流血、贫血表现各异体征生命体征平稳子宫=孕周无压痛胎儿存活子宫柔软生命体征平稳子宫孕周压痛胎儿存活阵发性宫缩生命体征不平稳子宫孕周压痛胎儿死亡持续性宫缩、子宫僵硬Clinical manifestation 临床表现临床表现40%Assisted examination 辅助检查辅助检查Assisted exa

9、mination 辅助检查辅助检查Assisted examination 辅助检查辅助检查Assisted examination 辅助检查辅助检查Diagnosis 诊断诊断 Symptoms and signs 症状和体征症状和体征. Ultrasound 超声超声. Lab examination 实验室检查实验室检查. Patients appearance is key point 最重要的是患者表现. Vaginal bleeding 阴道流血, uterine tenderness 子宫压痛, and contractions 收缩 are typical clinical m

10、anifestations.Differential diagnosis 鉴别诊断鉴别诊断胎盘早剥胎盘早剥胎盘前置胎盘前置病因妊娠高血压综合征创伤子宫内膜因素胎盘因素疼痛+-阴道流血与贫血各异同等子宫压痛+-子宫尺寸孕周=孕周胎儿危险/死亡存活胎盘检查凝块/压痕7cmComplication 并发症并发症Treatment Principle 治疗原则治疗原则Treatment Principle 治疗原则治疗原则1.Termination of pregnancy 终止终止妊娠妊娠 Vaginal delivery 阴道分娩阴道分娩: degree, in short time 短时间短时间

11、. Cesarean section 剖腹产剖腹产: degree. degree with fetal distress 胎儿胎儿窘迫窘迫. Fetal die, cant be delivered by vagina 阴道阴道 in short time.Treatment Principle 治疗原则治疗原则Treatment Principle 治疗原则治疗原则3. Treat postpartum hemorrhage 治疗产后出血治疗产后出血.nPromote uterine contractions 增强宫缩增强宫缩. Oxytocin 缩宫素缩宫素, massage uterus 按摩子宫按摩子宫. Uterine B-lynch suture 子宫背带式缝合术子宫背带式缝合术. Pack uterine cavity with ribbon gauze 宫腔填塞纱布条宫腔填塞纱布条.nUterine artery ligation. 子宫动脉结扎子宫动脉结扎nSubtotal hysterectomy