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PlacetalPreviaLongXiaoyu龍曉宇XuanWuHospital宣武醫(yī)院1.PlacetalPreviaLongXiaoyuCase1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase12.Case1.30G3P2at32weeksWhatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?3.Whatismostlikelydiagnosis?.Whatarethemostcommoncausesof

AntepartumHemorrhage?6.WhatarethemostcommoncauseCOMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselrupture

CervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorder

Unknown(byexclusionoftheabove)7.COMMONCAUSESPlacentaPreviaUNPlacentalPrevia8.PlacentalPrevia8.UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives9.UnderstandthatplacentaprevDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；

International：0.5%~0.9%。PlacentalPrevia10.Definedastheinferioredgeo“theplacentaoverlyingtheinternalosofthecervix”11.“theplacentaoverlyingtheiClassification12.Classification12.ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentaprevia13.ClassificationComplete(centralWhataretheriskfactorsforplacentalPrevia?Question

14.WhataretheriskfactorsforETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGY15.ETIOLOGYIncreasedmaternalageManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentation16.ManifestationClinicalPresentaManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.17.ManifestationTheclassTotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalMarginalplacentaprevia

Late(37-40WKSorinlabor)Lessbleeding18.TotalplacentapreviaPartialp

symptom

Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.

Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.19.symptomSeverebloodlComplicationofmother

andfetus

BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredelivery20.Complicationofmother

HowtodiagnosetheplacentalPrevia?Question

21.HowtodiagnosetheplacentalPatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”22.PatientHistory–PlacentaPrePhysicalExam–PlacentaPrevia

TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknown23.PhysicalExam–PlacentaPreviAuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI

PosteriorpreviaHighcostLimitedavailability24.AuxiliaryexaminationB-ultr25.25.Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowall26.Laboratory–PlacentaPreviaHeDifferentiation

diagnosisPlacentalabruptionvesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma

27.DifferentiationdiagnosisPlace28.28.Management

Expectantdelivery

aimatachievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.29.ManagementExpectantdelivery2Management

expectanttreatment

Indication:

FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g

Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfection30.ManagementexpectanttreatmenTerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement

31.TerminationofpregnancyManage32.32.Vaginaldelivery

Marginalplacentaprevia

VaginalbleedingislimitedManagement

33.VaginaldeliveryManagement33.AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement

34.Management34.PlacentaPrevia

ManagementSeverebleedingCaesareansectionModeratebleedingGestation>34<34ResuscitateSteroidsUnstableStableResuscitateMildbleedingGestation<36Conservativecare>36Management

35.PlacentaPrevia

ManagementSeveManagementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentation36.Managementofplacentaprevia?UltrasoundexaminationPlacenta

previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestation37.UltrasoundexaminationPlacentEachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1B38.EachofthefollowingisarisEachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2B39.EachofthefollowingisatyA33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingisthebestmanagementforthispatient?A)Inductionoflabor;B)Tocolysisoflabor;C)Cesareandelivery;D)ExpectantmanagementE)IntrauterinetransfusionExercise3C40.A33-year-oldwomanat37weeA22-year-oldG1P0womanat34week’sgestationpresentswithmoderatevaginalbleedingandnouterinecontractions.Whichofthefollowingsequenceofexaminationsismostappropriate?A)Speculumexamination,ultrasoundexamination,digitalexamination;B)Ultrasoundexamination,digitalexamination,speculumexamination;C)Digitalexamination,ultrasoundexamination,speculumexamination;D)Ultrasoundexamination,speculumexamination,digitalexamination;Exercise4D41.A22-year-oldG1P0womanat34An18-yeas-oldwomanisnotedtohaveamarginalplacentapreviaonanultrasoundexaminationat22week’sgestation.Whichofthefollowingisthemostappropriatemanagement?A)Schedulecesareandeliveryat39weeks;B)Scheduleanamniocentesisat36weeksanddeliverbycesareanifthefetallungsaremature;C)ScheduleanMRIexaminationat35weekstoassessforpossiblepercretainvolvingthebladder;D)Reassessplacentalpositionat32weeksE)RecommendterminationofpregnancyExercise5D42.An18-yeas-oldwomanisnotedUnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives43.Understandthatplacentaprev44.44.后面內容直接刪除就行資料可以編輯修改使用資料可以編輯修改使用資料僅供參考，實際情況實際分析45.后面內容直接刪除就行45.感謝您的觀看和下載Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield46.感謝您的觀看和下載TheusercandemonstrPlacetalPreviaLongXiaoyu龍曉宇XuanWuHospital宣武醫(yī)院47.PlacetalPreviaLongXiaoyuCase1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase148.Case1.30G3P2at32weeksWhatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?49.Whatismostlikelydiagnosis?.Whatarethemostcommoncausesof

AntepartumHemorrhage?52.WhatarethemostcommoncauseCOMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselrupture

CervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorder

Unknown(byexclusionoftheabove)53.COMMONCAUSESPlacentaPreviaUNPlacentalPrevia54.PlacentalPrevia8.UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives55.UnderstandthatplacentaprevDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；

International：0.5%~0.9%。PlacentalPrevia56.Definedastheinferioredgeo“theplacentaoverlyingtheinternalosofthecervix”57.“theplacentaoverlyingtheiClassification58.Classification12.ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentaprevia59.ClassificationComplete(centralWhataretheriskfactorsforplacentalPrevia?Question

60.WhataretheriskfactorsforETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGY61.ETIOLOGYIncreasedmaternalageManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentation62.ManifestationClinicalPresentaManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.63.ManifestationTheclassTotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalMarginalplacentaprevia

Late(37-40WKSorinlabor)Lessbleeding64.TotalplacentapreviaPartialp

symptom

Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.

Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.65.symptomSeverebloodlComplicationofmother

andfetus

BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredelivery66.Complicationofmother

HowtodiagnosetheplacentalPrevia?Question

67.HowtodiagnosetheplacentalPatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”68.PatientHistory–PlacentaPrePhysicalExam–PlacentaPrevia

TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknown69.PhysicalExam–PlacentaPreviAuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI

PosteriorpreviaHighcostLimitedavailability70.AuxiliaryexaminationB-ultr71.25.Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowall72.Laboratory–PlacentaPreviaHeDifferentiation

diagnosisPlacentalabruptionvesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma

73.DifferentiationdiagnosisPlace74.28.Management

Expectantdelivery

aimatachievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.75.ManagementExpectantdelivery2Management

expectanttreatment

Indication:

FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g

Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfection76.ManagementexpectanttreatmenTerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement

77.TerminationofpregnancyManage78.32.Vaginaldelivery

Marginalplacentaprevia

VaginalbleedingislimitedManagement

79.VaginaldeliveryManagement33.AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement

80.Management34.PlacentaPrevia

ManagementSeverebleedingCaesareansectionModeratebleedingGestation>34<34ResuscitateSteroidsUnstableStableResuscitateMildbleedingGestation<36Conservativecare>36Management

81.PlacentaPrevia

ManagementSeveManagementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentation82.Managementofplacentaprevia?UltrasoundexaminationPlacenta

previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestation83.UltrasoundexaminationPlacentEachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1B84.EachofthefollowingisarisEachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2B85.EachofthefollowingisatyA33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingis