产后出血八年制

PostpartumHemorrhageDefinition Abloodlossof500mlormoreinthefirst24hoursafterdeliveryAdescription,notadiagnosisTheprimarycauseofmaternalmortalityPredisposingfactorsandcausesUterineatonyPlacentaabnormityTraumatothegenitaltractCoagulationdefects1.UterineAtony(子宫收缩乏力)ObstetricfactorProlongedlabor滞产Precipitatedelivery(delivery<3hrs)急产Pregnantcomplications

placentaprevia

placentalabruption

chorioamnionitis(绒毛膜羊膜炎)Oxytocin-inducedlabor引产Augmentedlabor催产1.UterineAtony(子宫收缩乏力)SystemicfactorPsychologicalfactorsTocolyticagent宫缩抑制剂Conductionanalgesia(镇痛分娩)UterusfactorOverdistendeduterus:largefetus,twins,hydramniosUterusmyoma,historyofCS,myomectomyHighparityIncidenceIncidence

ofPPHPPHofUterineAtony2.PlacentalfactorsRetainedplacentaltissuePlacentaSuccentuiatelobe(副叶胎盘)Embryolema(胎膜)AbnormallyadherentAccreta,increta,percreta(粘连，植入，穿透)3.TraumatothegenitaltractCausesPrecipitatedelivery急产,largefetusUnthoroughHemostasis(止血)Lacerationofperineum,vagina,cervixUterineRuptureHaematomas4.CoagulationdefectsPregnantcomplicationsAmnioticfluidembolism(AFE,羊水栓塞)HypertensivedisordersinpregnancyPlacentalabruptionStillbirthHaematologicaldiseasesIdiopathicthrombocytopenic(ITP,特发性血小板减少性紫癜),Aplasticanemia(AA,再生障碍性贫血)ClinicalmanifestationVaginalbleeding出血发生时间有无凝血块血肿？SymptomsofshockDiagnosisEstimatingbloodlossVisualestimationObjectivemeasurement称重法面积法10cm*10cm=10mlShockindexHR/SBP=0.5normal1.0bloodloss20~30%

1.5bloodloss30~50%

2.0bloodloss>50%DiagnosisCauseanalysisUterineAtony:asoft,boggyuterus

正常胎儿娩出后宫底位置？Placentalfactors

正常胎盘娩出时间？如何检查？

DiagnosisCauseanalysisTraumaPerineallacerationVaginallaceration,hematomaCervicaltraumaCoagulationdisordersHistoryLabtestManagementOrganizationofthemultidisciplinaryteam组织抢救Restorationofbloodvolume补充血容量Correctionofdefectivecoagulationwithbloodproductsandfactors纠正凝血功能Evaluationofresponsetotreatmentbyhaemodynamicandlaboratoryassessment评估Remedyingoftheunderlyingcause治疗原发病ManagementEtiologicaltreatmentHomostasis(止血)Anti-shock:bloodtransfusionAntibioticprophylaxisUterineAtonyEmptyingofthebladderStimulatinguterinemuscletonebimanualcompression,uterinemassageUterotonicagentsOxytocinErgometrine麦角新碱ProstaglandinsTamponade填塞UterineAtonyUterinecompressionsutures：B-lynchAngiographicarterialembolization动脉栓塞ArterialligationHysterectomyPlacentalfactorsManualremovalCuretage:Ringcuret刮宫术Placentaincretaorpercreta:hystorectomyTraumaLacerationsSurgicalrepair:upperangleHematomasSmall:expectantly,incisionandsutureEnlarged:promptincision,drainageCoagulationdefectsTransfusiontherapyRedbloodcells(RBCs)PlateletsFresh-frozenplasmaCoagul