(妇产科学课件）8.4（参考翻译）Placental Abruption

(妇产科学课件）8.4（参考翻译）PlacentalAbruption1.Previousplacentalabruption既往胎盘早剥.Acommonpredisposingfactor诱因ispreviousplacentalabruption.Followingoneepisode段,therateofrecurrence再发is10%~17%.Following2episodes段,therateofrecurrence再发生率exceeds超过20%.Etiology病因Etiology病因2.Maternalvasculardiseases母体血管疾病.Hypertensioninpregnancy妊娠期高血压(preeclampsia子痫前期)Chronichypertension慢性高血压Chronickidneydisease慢性肾脏病Spasmofspiralarteries螺旋动脉痉挛causedcapillariesrupture毛细血管破裂indeciduabasalis底蜕膜.Etiology病因3.Mechanicalfactors机械因素Trauma创伤Sex性别Amniocentesis（羊膜腔穿刺术）Etiology病因4.Uterinevolumedecreasedsuddenly子宫容积突然减小.Ruptureofmembranes胎膜破裂inpolyhydramnios（羊水过多）.Twins,1stoneisdeliveredtooquicklyUterinevolumedecreasegreatlyUterinecavitypressuredropUterinecontractions宫缩Abruption剥离Etiology病因5.Uterinevenouspressurerosesuddenly子宫静脉压突然升高Supinehypotensivesyndrome（仰卧位低血压综合征）UterinevenouspressurerosesuddenlyDeciduaveincongestionorrupture蜕膜静脉淤血或破裂Placentalabruption6.Smoking,cocaineandothers.Pathology病理Basicpathology基本病理：Deciduabasalis底蜕膜bleedingRetroplacentalhematomaPlacentaseparateRetroplacentalhematoma胎盘后血肿Pathologyclassification病理分类Revealedabruption显性剥离Concealedabruption隐性剥离Mixedbleeding混合型出血RevealedabruptionConcealedabruptionMixedbleedingPathologyclassification病理分类RevealedabruptionConcealedabruptionMixedbleedingPathologyclassification病理分类1.Revealedabruption显性剥离Bleedingextendstowardcervix宫颈,leadingtoexternal表面的orvisible可见的bleeding.2.Concealedabruption隐性剥离Bleedingstaysbetweenplacentaanduterinewall子宫壁,cannotflowout,resultingininternalhemorrhage内出血.FundusofUterusrises.子宫底抬高Pathologyclassification病理分类Retroplacentalhematoma胎盘后血肿Pathologyclassification病理分类3.Mixedbleeding混合型出血(mixedabruption混合性剥离)Revealedbleeding显性流血+Concealedbleeding隐性流血Pathophysiology病理生理1.Uteroplacentalapoplexy子宫胎盘卒中Pressureofhematoma血肿increased.Bloodinvadedinto侵入themyometrium子宫肌层.Musclefibers肌纤维wereseparatedfromeachother,evenbroken.Serousmembrane浆膜turnedblueanddark.Uteroplacentalapoplexy子宫胎盘卒中子宫胎盘卒中Uteroplacentalapoplexy子宫胎盘卒中Uteroplacentalapoplexy子宫胎盘卒中Pathophysiology病理生理2.Coagulationdisorders凝血功能紊乱PlacentalabruptionReleaseofthrombokinase凝血活酶ActivatecoagulationsystemConsumematernalcoagulationsubstance消耗母体凝血物质disseminatedintravascularcoagulation(DIC)Clinicalmanifestation临床表现Sudden,acuteabdominalpain.突然、急剧的腹痛Vaginalbleedinginthirdtrimester.妊娠晚期阴道流血CHARACTERofbleedingPainfulⅠⅡⅢ尺寸<1/3约1/3>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Clinicalmanifestation临床表现40%Assistedexamination辅助检查Ultrasound超声Laboratoryexamination实验室检查Assistedexamination辅助检查1.Ultrasound超声Excludeplacentaprevia.排除胎盘前置Usefulbutnottotallyreliable.有用但不可完全依赖Assistedexamination辅助检查2.Laboratoryexamination实验室检查Assistedexamination辅助检查Routinebloodtest血常规试验:hemoglobin(HB),platelet(PLT).Coagulationfunctiontest凝血功能试验orDICtest.Diagnosis诊断Symptomsandsigns症状和体征.Ultrasound超声.Labexamination实验室检查.Patient’sappearanceiskeypoint最重要的是患者表现.Vaginalbleeding阴道流血,uterinetenderness子宫压痛,andcontractions收缩aretypicalclinicalmanifestations.Differentialdiagnosis鉴别诊断胎盘早剥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DICandcoagulationdisorders凝血功能障碍Postpartumhemorrhage产后出血Acutekidneyfailure急性肾衰竭Amnioticfluidembolism羊水栓塞Fetaldeath胎儿死亡TreatmentPrinciple治疗原则Anti-shocktherapy抗休克治疗Terminationofpregnancyintime适时终止妊娠Treatcomplications治疗并发症:Coagulationdisorder凝血功能障碍andDICAcutekidneyfailure急性肾衰竭Postpartumhemorrhage产后出血TreatmentPrinciple治疗原则1.Terminationofpregnancy终止妊娠Vaginaldelivery阴道分娩:Ⅰdegree,inshorttime短时间.Cesareansection剖腹产:Ⅱ~Ⅲdegree.Ⅰdegreewithfetaldistress胎儿窘迫.Fetaldie,can’tbedeliveredbyvagina阴道inshorttime.TreatmentPrinciple治疗原则2.TreatDIC.Spontaneousbleeding自发性出血:nose,intravenousinjectionsite静脉注射部位.Componentbloodtransfusion成分输血:RBC,platelet,coagulationfactor凝血因子.TreatmentPrinciple治疗原则3.Treatpostpartumhemorrhage治疗产后出血.Promoteuterinecontractions增强宫缩.Oxytocin缩宫素,massageuterus按摩子宫.UterineB-lynchsuture子宫背带式缝合术.Packuterinecavitywithribbongauze宫腔填塞纱布条.Uterinearteryligation.子宫动脉结扎Subtotalhysterectomy次全子宫切除.Oxytocin缩宫素,massageuterine按摩子宫UterineB-lynchSuture子宫背带式缝合术Packuterinecavitywithribbongauze宫腔填塞纱布条Uterinearteryligation子宫动脉结扎