产科并发症英文课件

LATERPREGNANCYCOMPLICATIONSPrematuredeliveryProlongedpregnancyPrematureRuptureofMembranes

(PROM)ContentPRETERMLABOR早产Etiology:1.Obstetriccomplications

产科并发症2.Medicalcomplications

内科并发症3.Surgicalcomplications

外科并发症4.Genitaltractanomalies

生殖道畸形1.Obstetriccomplications:SeverehypertensivestateorpregnancyAnatomicdisorderoftheplacenta(abruptioplacentae,placentaprevia)PrematureruptureofmembranesPolyhydramniosoroligohydramniosMultiplepregnancyPreviouslaceration（裂伤）ofcervixoruterus2.Medicalcomplications:PulmonaryorsystemichypertensionRenaldiseaseHeartdiseaseInfection:genitaltractinfection,urinarytractinfection,pyelonephritis肾盂肾炎,acutesystemicinfectionHeavycigarettesmokingAlcoholismordrugaddictionSevereanemiaClinicalFinding&Diagnosis1.SymptomandSignUterine

contractions—morethan2inone-halfhour;Vaginalbleeding-bloodymucousvaginaldischargeor“bloodyshow”;Dilatation扩张andeffacement消退of

cervix-changeindilatationoreffacementofatleast1cmoracervixthatiswelleffacedanddilatated(atleast2cm);2.LaboratoryStudiesCompletelybloodcountwithdifferentialCervixdischargecultures：shouldbesentforgonorrhea淋病andchlamydia衣原体.Fetalfibronectin纤连蛋白（Ffn):negativetestiseffectiveatrulingoutimminentdelivery(within2weeks)；positivetest（Ffn>50ng/ml):resultissensitiveatpredictingpretermbirth.分泌物3.Accessoryexamination:Ultrasound

examinationforfetalsize,position,placentalocation，andcervicallength.

Cervicallength>30nm:prognosticatingprematuredelivery.

Infundibulum漏斗lengthofcervicalinternalos>25%CervicallengthorAmniocentesistoascertainfetallungmaturity,theamniofluid羊水betestedforlecithin卵磷脂/sphingomyelin鞘磷脂(L/S)ratio1.Bedrest：2.Corticosteroids:

toacceleratefetallungmaturity

Betamethason倍他米松:12mgIM1/24hr×2dosesDexamethasone地塞米松:6mgIM1/12hr×4doses3.Antibiotics:

nobenefitindelayingpretermbirth.4.Tocolysis：

4.Tocolysis

Tocolytictherapyshouldbeconsideredinthepatientwithcervicaldilationlessthan3cm.(1)Beta-MimeticAdrenergicAgentsβ肾上腺受体激动剂

Ritodrine利托君，Terbutaline特布他林，salbutamol沙丁胺醇：(2)Magnesiumsulfate硫酸镁:firstlineagentfortocolysis;(3)CalciumChannelBlockers钙离子通道拮抗剂;

nifedipine硝苯地平(4)ProstaglandinSynthetaseInhibitors前列腺素合成抑制剂

indomethacin吲哚美辛

Somecasesinwhichpretermlaborshouldnotbesuppressed.

Maternalfactors:Fetalfactors:Maternalfactors:SeverehypertensivediseasePulmonaryorcardiacdiseaseAdvancedcervicaldilationMaternalhemorrhageManneroflabor1.Vaginaldelivery:

perineumsection会阴切开术2.Cesareansection:

abnormalfetalposition胎位异常

fetaldistress胎儿窘迫

maternalhemorrhage孕妇出血

severematernalcomplications孕妇严重的并发症

CaseFileAhealthy20-year-oldpregnantwoman,G1P0at29weeks’gestationpresenttothelaboranddeliveryareacomplainingofintermittenabdominalpain.Shedeniesleakageoffluidorbleedingpervagina.Herantenatalhistoryhasbeenunremarkable.Shehasbeeneatinganddrinkingnormally.Onexamination,thefetalheartratetracingrevealsabaselineheartrateof120bpmandreactivepattern.Uterinecontractionareoccuringevery3to5min.Onpelvicexamination,hercervixis1cmdilated,90%effaced,andfetalvertexispresentingat-1station.

Whatisthemostlikelydiagnosis?

Pretermlabor.Whatisyournextstepinmanagement?

Tocolysis,trytoidentifyacauseofthepretermlabor,antenatalsteroids,andantibiotics.QuestionsGeneralconsideration:Definition:

Prolongedpregnancyisdefinedaspregnancythathasreached42weeksofcompletedgestationfromthefirstdayoftheLMPor40weeks’gestationfromthetimeofconception.

Thematernalrisk:

Relatedtoextraordinaryfetalsize:Dysfunctionallabor功能障碍性分娩Arrestedprogressoflabor产程停止Fetopelvicdisproportion胎盆不称Cesareansection剖宫产Labortrauma分娩损伤Effecttofetus:

Impairednutritionalsupply(weightloss,reducedsubcutaneoustissue,scaling脱皮,parchmentlikeskin羊皮纸样皮肤)----dysmaturity成熟障碍

Birthinjury(shoulderdystocia肩难产)

Oligohydramnios羊水过少

Fetaldistress胎儿窘迫Meconiurnaspirationsyndroame（MAS)胎粪吸入综合征Asphyxianeonatorum新生儿窒息PATHOLOGYPlacenta:normalorhypofunction功能减退Amnioticfluid:Oligohydramnios羊水过少Meconiumdyeofamnioticfluid羊水粪染Fetus:Fetalmacrosomia巨大胎儿Fetaldysmaturity胎儿成熟障碍Small-for-dateinfant小样儿Diagnosis:1.Confirmationofgestationalage:byreferringtorecordsof:Mecialhistory:

LMP,theexacttimeofconception,ovulatetime,etal;Clinicalexpression:earlypregnancyreaction,quickeningtime,gynecologicalexaminationinfirsttrimester,etal;Laboratorytests:

ultrasound:examination,andclinicalparametersofearlypregnancy(e.g,hCG)1.Inducedlabor:

Cervixismature,bishopscore>7

Whencervixismature:人工破膜Oxytocin,Prasterone普拉睾酮Prostaglandin前列腺素：

propess普贝生(DinoprostoneSuppositories地诺前列酮栓）3.Cesareansection:Failureofinducedlabor;Arrestedprogressoflabor;Fetaldistress;Disposition;Largefetus;Amnioticfluidisabnormal;Pregnancycomplications;Fetalcompromise:breechpresentation,etal.PrematureRuptureofMembranes

(PROM)DEFINITIONThefetalmembranerupturehappensbeforelabor.Prematureruptureofmembranecancausepretermlabor,prolapseofumbilicalcord,andmaternalandfetalinfection.Thelessthegestationalage,theworsetheprognosisoftheperinatalinfant.EssentialsofDiagnosis1.Historyofagushoffluidfromthevaginaorwateryvaginaldischarge;2.Demonstrationofamnioticfluidleakagefromthecervix.ETIOLOGYGenitaltractpathogenicmicroorganismupgoinginfection:Amnioticcavitypressureincrease:Pressureonfetalmembraneisunbalanced;Nutritionalfactor;Cervicalincompetence;Cytokine:Pathology&PathophysiologyPretermlaborProlapseoftheumbilicalcordPlacentaabruptionIntrauterineinfectionChorioamnionitisDIAGNOSIS1.SymptomSuddengushoffluidorcontinuedleakageThecolorandconsistencyofthefluidandthepresenceofVernixcaseosa胎脂ormeconium胎粪,reducesizeoftheuterus,andincreasedprominenceofthefetustopalpation.2.SterilespeculumexaminationPooling:thecollectionofamnioticfluidintheposteriorfornix;Nitrazinetest:thenitrazinepaperturnsblue,demonstratinganalkalinePH(7.0-7.25);Ferning:Fluidfromtheposteriorfornixisplacedonaslideandallowedtoair-dry.Amnioticfluidwillformafernlikepatternofcrystallization;Becareoffalsenegativeresult:vaginalinfections,presenceofbloodorsemen3.Physicalexamination:Tosearchforothersignsforinfection.4.Laboratorystudies:CompletebloodcountwithdifferentialUltrasoundexaminationforfetalsizeandamnioticfluidindexAmniocentesistodeterminefetallungmaturityandthepresenceofinfection5.ChorioamniotisThemostreliablesignsofinfectioninclude:Fever:thetemperatureshouldbecheckedevery4hoursMaternalleukocytosis:dailyleukocytecountanddifferential.Anincreaseinthewhitebloodcellcountorneutrophilcountmayindicatethepresenceofintra-amnioticeinfectionUterinetenderness:checkevery4hoursTachycardia:eithermaternalpulse﹥100bpmorfetalheart﹥160bpmissuspicious.InfluenceonMotherandFetusInfluenceonmother:Infection;PlacentaabruptionInfluenceonfetus:Prematuredelivery→respiratorydistresssyndromeofnewborn新生儿呼吸窘迫综合