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胎盘早剥

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placental abruption. 胎盘早剥. Definition. After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption. Etiology. Vascular injury

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Presentation Transcript
definition
Definition

After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption

etiology
Etiology
  • Vascular injury

PIH syndrome

chronic renal disease

  • mechanical factors

twins

polyhydramnios

short umbilical cord

  • suddenly rising of the uterus venous pressure
pathophysiology
Pathophysiology
  • The hemorrhage in the decidua
  • forming hematoma behind placenta
  • separate from wall of the uterus
classification
Classification
  • A revealed abruption
  • B concealed abruption
  • C mixed hemorrhage
slide9
病 例

王铭,女,27岁,以“停经九个月,胎动五个月,突发性下腹痛伴阴道流血一小时”为主诉入院。平素月经规律,早孕 反应不明显,孕18周觉胎动,活跃至今,一小时前无明显诱因突发下腹痛,阴道 少量流血,鲜红,无意识模糊等表现。

查体:T37.2℃,P21次/分,BP85/55mmHg,心肺听诊无异常,腹 膨隆,孕足月腹, 纵产式腹肌紧张,子宫易激惹,右下腹有一局限性压痛点,阴道流血少量。

slide10
实验室检查:血常RBC2OO×1012/L,HGB8.7g/L,WBC11.4×109。

辅助检查:B超示BPD9.5cm,FL7.4 cm,胎盘位于后壁,与子宫间见一个3× 5cm 低回声区,未见胎心反射。

clinical manifestations
Clinical manifestations

Mild type

during labor

revealed abruption

<1/3 in size

vaginal bleeding

slight abdominal pain

uterus is soft

fetal position is clear

fetal heart sounds is clear

clinical manifestations1
Clinical manifestations

Severe type

PIH symptoms

concealed or mixed abruption

>1/3 in size

a lot of blood

uterus enlarged rapidly

increasing pain

pallor out of proportion to amount of vaginal bleeding

fetal position is not clear

fetal heart sound disappear

assistant examination
Assistant examination
  • B-ultrasound examination
  • laboratory findings

A the degree of anemia

B funtion of coagulation

diagnosis
Diagnosis
  • History
  • signs
  • examination
  • assistant examination
differential diagnosis
Differential diagnosis
  • Placenta previa
  • impending rupture of uterus
complications
Complications
  • DIC and dysfunction clotting
  • postpartum hemorrhage
  • acute renal failure
  • Sheehan, s syndrome
prevention
Prevention
  • Improving prenatal care
  • improving treatment for high

risk pregnancy

trestment
Trestment⑴
  • Correct shock
  • terminating pregnancy

A vaginal delivery

B cesaerean section

  • Preventingpostpartum

hemorrhage

treatment
Treatment⑵
  • Treating the dysfunctional clotting

A transfusing fresh blood

B transfusing fibrinogen(纤维蛋白原)

C transfusing fresh plasma

D use of heparin(肝素)

E anti-fibrinogenolysis agent(抗纤溶剂)

  • preventing failure of renal function

urine volume<30ml/h 补充血容量

<17ml/h 肾衰