(婦產(chǎn)科學(xué)課件）8.4（參考翻譯）Placental Abruption

1、( (婦產(chǎn)科學(xué)課件）婦產(chǎn)科學(xué)課件）8.48.4（參考翻譯）（參考翻譯）Placental Placental AbruptionAbruption A common predisposing factor 誘因誘因 is previous placental abruption. Following one episode 段段, the rate of recurrence 再發(fā)再發(fā) is 10% 17%. Following 2 episodes 段段, the rate of recurrence 再發(fā)再發(fā)生率生率 exceeds 超過(guò)超過(guò) 20%.Etiology 病因病因Etiolo

2、gy 病因病因 Hypertension in pregnancy 妊娠期高血壓妊娠期高血壓 (preeclampsia 子癇前期子癇前期) Chronic hypertension 慢性高血壓慢性高血壓 Chronic kidney disease 慢性腎臟病慢性腎臟病Spasm of spiral arteries 螺旋動(dòng)脈痙攣螺旋動(dòng)脈痙攣 caused capillaries rupture 毛細(xì)血管破裂毛細(xì)血管破裂 in decidua basalis 底蛻膜底蛻膜.Etiology 病因病因Etiology 病因病因Etiology 病因病因Pathology 病理病理Retropl

3、acental hematoma 胎盤(pán)后血腫胎盤(pán)后血腫Pathology classification 病理分類病理分類 Revealed abruption 顯性剝離顯性剝離 Concealed abruption 隱性剝離隱性剝離 Mixed bleeding 混合型出血混合型出血Revealed abruptionConcealed abruptionMixed bleedingPathology classification 病理分類病理分類Revealed abruptionConcealed abruptionMixed bleedingPathology classificati

4、on 病理分類病理分類 1. Revealed abruption 顯性剝離 Bleeding extends toward cervix 宮頸宮頸, leading to external 表面的表面的 or visible 可見(jiàn)的可見(jiàn)的 bleeding.2. Concealed abruption 隱性剝離隱性剝離 Bleeding stays between placenta and uterine wall 子宮壁子宮壁, can not flow out, resulting in internal hemorrhage 內(nèi)出血內(nèi)出血. Fundus of Uterus rises

5、. 子宮底抬高子宮底抬高Pathology classification 病理分類病理分類Retroplacental hematoma 胎盤(pán)后血胎盤(pán)后血腫腫Pathology classification 病理分類病理分類3. Mixed bleeding 混合型出血混合型出血(mixed abruption 混合性剝離混合性剝離)Revealed bleeding 顯性流血顯性流血+Concealed bleeding 隱性流血隱性流血Pathophysiology 病理生理病理生理1.Uteroplacental apoplexy 子宮胎子宮胎盤(pán)卒中盤(pán)卒中 Pressure of hem

6、atoma 血腫血腫 increased. Blood invaded into 侵入侵入 the myometrium 子宮肌層子宮肌層. Muscle fibers 肌纖維肌纖維 were separated from each other, even broken. Serous membrane 漿膜漿膜 turned blue and dark.Uteroplacental apoplexy 子宮胎盤(pán)卒中子宮胎盤(pán)卒中子宮胎盤(pán)卒中Uteroplacental apoplexy子宮胎盤(pán)卒中子宮胎盤(pán)卒中Uteroplacental apoplexy 子宮胎盤(pán)卒中子宮胎盤(pán)卒中Pathophy

7、siology 病理生理病理生理2.Coagulation disorders 凝血功能紊亂凝血功能紊亂Placental abruptionRelease of thrombokinase 凝血活酶凝血活酶 Activate coagulation systemConsume maternal coagulation substance 消耗母體凝血物質(zhì)消耗母體凝血物質(zhì)disseminated intravascular coagulation(DIC)Clinical manifestation 臨床表現(xiàn)臨床表現(xiàn) Sudden, acute abdominal pain. 突然、急劇的腹痛

8、突然、急劇的腹痛 Vaginal bleeding in third trimester. 妊娠晚期陰道流血妊娠晚期陰道流血CHARACTER of bleeding Painful尺寸1/2類型顯性顯性/隱性隱性/混合性癥狀無(wú)腹痛輕度流血無(wú)貧血突發(fā)疼痛陰道流血、貧血表現(xiàn)各異突發(fā)疼痛陰道流血、貧血表現(xiàn)各異體征生命體征平穩(wěn)子宮=孕周無(wú)壓痛胎兒存活子宮柔軟生命體征平穩(wěn)子宮孕周壓痛胎兒存活陣發(fā)性宮縮生命體征不平穩(wěn)子宮孕周壓痛胎兒死亡持續(xù)性宮縮、子宮僵硬Clinical manifestation 臨床表現(xiàn)臨床表現(xiàn)40%Assisted examination 輔助檢查輔助檢查Assisted exa

9、mination 輔助檢查輔助檢查Assisted examination 輔助檢查輔助檢查Assisted examination 輔助檢查輔助檢查Diagnosis 診斷診斷 Symptoms and signs 癥狀和體征癥狀和體征. Ultrasound 超聲超聲. Lab examination 實(shí)驗(yàn)室檢查實(shí)驗(yàn)室檢查. Patients appearance is key point 最重要的是患者表現(xiàn). Vaginal bleeding 陰道流血, uterine tenderness 子宮壓痛, and contractions 收縮 are typical clinical m

10、anifestations.Differential diagnosis 鑒別診斷鑒別診斷胎盤(pán)早剝胎盤(pán)早剝胎盤(pán)前置胎盤(pán)前置病因妊娠高血壓綜合征創(chuàng)傷子宮內(nèi)膜因素胎盤(pán)因素疼痛+-陰道流血與貧血各異同等子宮壓痛+-子宮尺寸孕周=孕周胎兒危險(xiǎn)/死亡存活胎盤(pán)檢查凝塊/壓痕7cmComplication 并發(fā)癥并發(fā)癥Treatment Principle 治療原則治療原則Treatment Principle 治療原則治療原則1.Termination of pregnancy 終止終止妊娠妊娠 Vaginal delivery 陰道分娩陰道分娩: degree, in short time 短時(shí)間短時(shí)間

11、. Cesarean section 剖腹產(chǎn)剖腹產(chǎn): degree. degree with fetal distress 胎兒胎兒窘迫窘迫. Fetal die, cant be delivered by vagina 陰道陰道 in short time.Treatment Principle 治療原則治療原則Treatment Principle 治療原則治療原則3. Treat postpartum hemorrhage 治療產(chǎn)后出血治療產(chǎn)后出血.nPromote uterine contractions 增強(qiáng)宮縮增強(qiáng)宮縮. Oxytocin 縮宮素縮宮素, massage uterus 按摩子宮按摩子宮. Uterine B-lynch suture 子宮背帶式縫合術(shù)子宮背帶式縫合術(shù). Pack uterine cavity with ribbon gauze 宮腔填塞紗布條宮腔填塞紗布條.nUterine artery ligation. 子宮動(dòng)脈結(jié)扎子宮動(dòng)脈結(jié)扎nSubtotal hysterectomy