Transcript Document 7188271

胎盘早期剥离
Placental Abruption
Zongjun Hao
Department of Ob & Gy
Taian public Health School of Shandong Province
病例
孕妇，30岁，G1P0 ，36周妊娠，2h前
腹部受外伤后出现持续性腹痛而入院。检查：
孕妇面色苍白，血压60/40 mmHg，胎心率
100次/min，子宫底位于剑突下2横
指，
子宫压痛，张力高。正确处理方法为：
A、给予镇静止痛剂
B、纠正休克后继续妊娠
C、纠正休克，同时行剖宫产术
D、应用子宫收缩抑制剂
C
学习目标
sdudying
Aims
Grasp the definition 、 Etiology 、
Pathology 、Clinical chracateristic and
priciples of placental abruption.
掌握胎盘早剥的定义、 发病原因、
病理及其临床特点和治疗原则
重 点
Etiology 、 Clinical chracateristic and
emphasis Treatment病因和治疗原则
难点
Difficult
points
Pathology of placental abruption.
胎盘早剥的病理
General Consideration
• Definition 定义
The separation of the placenta from its site
of implantation after 20 weeks of gestation or
during the course of delivery.
妊娠20周后或在分娩期发生正常位置的胎盘发生
部分或全部从子宫壁剥离。
• perinatal morbidity发病率
0.46%-2.1% (our country)
1%
(other countries）
• perinatal mortality死亡率
20%-35%
Etiology 病因
Risk factors
1、Vascular diseases: 血管疾病
preeclampsia, chronic hypertension, renal
disease.
先兆子痫、慢性高血压、慢性肾病等
2、Mechanical factors: 机械性损伤
trauma, intercourse etc.
外伤 、性生活 、外倒转术纠正胎位等
Etiology 病因
Risk factors
3、Supine hypotensive syndrome
仰卧位低血压综合征
4、reducing of uterine presure suddenly
宫腔内压力骤降
multiple gestaion, hytramnios etc.
5、others:其它
short umbilical cord etc.
脐带过短、绕颈等
Pathology
• Main change 主要病理改变
hemorrhage of the decidua basalis
底蜕膜出血
Pathology change
hemorrhage of the decidua basalis
底蜕膜螺旋动脉破裂出血
→ decidua splits
底蜕膜分离
→ decidural hematoma 底蜕膜血肿
→ separation, compression, destruction
of the placenta adjacent to it
剥离、出血、挤压、剥离→恶性循环
Pathology
Types分类
revealed abruption 显性剥离
concealed abruption 隐性剥离
mixed
abruption 混合剥离
Clinical chracteristics
• Sudden ， continuous
abdominal pain
突然的、持续的腹痛
•
Vaginal bleeding
阴道出血
Complication并发症
•
•
•
•
•
•
Uteroplacental apoplexy
Hypovolemic shock
Amniotic fluid embolism
Acute renal failure
Postpartum hemorrhage
DIC
子宫胎盘卒中
低血容量性休克
羊水栓塞
急性肾功能衰竭
产后出血
弥漫性血管内凝血
Treatment
• Treatment of hypovolemic shock: 抗休克
intensive transfusion with blood
• Termination of pregnancy 尽快终止妊娠
promptly :
Cesarean or Vaginal delivery
• Control complications：
控制并发症
homework
初孕妇，29岁，妊娠35周，以往无高血压病
史，近一周来血压160~170/100~110mmHg，现因
下腹痛3h伴阴道流血入院，如果你是接诊护士，
你首先想到是什么疾病？
Thank you !
Pathology 1
revealed abruption
显性出血
Pathology 2
concealed abruption
隐性出血
Pathology 3
mixed abruption
混合性出血