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1、胎盘早期剥离与前置胎盘placentalabruptionPlacentapervia李爱斌•概述•病因•病理变化•临床表现•处理原则内容提要•解释胎盘早剥定义•了解病因及病理变化•掌握临床表现•熟悉处理原则学习目的与要求【概述】•胎盘早剥——指妊娠20周以后或分娩期，正常位置的胎盘在胎儿娩出前，部分或全部从子宫壁剥离•是严重威胁产妇及胎儿生命的并发症•围生儿死亡率高GeneralConsiderationDefinitionTheseparationoftheplacentafromitssiteofimplantation
2、after20weeksofgestationorduringthecourseofdelivery.Frequency0.46%-2.1%(ourcountry)1%-2%(othercountries)Incidenceoffetaldeath200‰-350‰•血管病变•机械性因素(外伤、脐带过短）•子宫静脉压突然升高•子宫体积突然缩小【病因】未明EtiologyUncertain(primarycause)RiskfactorsIncreasedageandparityVasculardiseases:preeclam
3、psia,chronichypertension,renaldisease.Mechanicalfactors:trauma,intercourse,polyhydramnios,SupinehypotensivesyndromeSmoking,cocaineuse,uterinemyoma【病理变化】•主要病理变化是底蜕膜出血形成血肿胎盘自附着处剥离出血腹痛（持续性）PathologyMainchangehemorrhageintothedeciduabasalis→deciduasplits→deciduralhemato
4、ma→separation,compression,destructionoftheplacentaadjacenttoitTypesrevealedabruption,concealedabruption,mixedtypeUteroplacentalapoplexy子宫胎盘卒中•出血形式显性出血混合性出血隐性出血母体——贫血、失血性休克、DIC、子宫卒中、产后出血、感染、多脏器功能衰竭围生儿——胎儿窘迫、新生儿窒息、RDS、新生儿死亡•并发症DICHypovolemicshockAmnionicfluidembolismA
5、cuterenalfailureComplication【临床表现】轻型重型出血外出血为主，内出血为主，阴道出量较多血少或无腹痛轻或无持续性、剧烈子宫软，轻压痛，子宫硬，压痛明显，大小与孕月相符，子宫大于孕月，胎位胎位、胎心清楚不清，胎心音异常腹部检查【常用辅助检查】•B超•实验室检查——贫血程度、凝血功能、肝肾功能等DiagnosissignandsymptomVaginalbleedingUterinetendernessorbackpainFetaldistressHighfrequencycontractionsHyp
6、ertonusIdiopathicpretermlaborDeadfetusDiagnosisUltrasonographyDifferentialdiagnosisPlacentapreviaPainlessbleedingPre-ruptureofuterusdystocia【处理原则】•补充血容量，防治休克；及时终止妊娠，防治并发症•终止妊娠方法——剖宫产——阴道分娩TreatmentTreatmentwillvarydependingupongestationalageandthestatusofmotherandfe
7、tusTreatmentofhypovolemicshock:intensivetransfusionwithbloodAssessmentoffetusTerminationofpregnancy:CSorVaginaldeliveryTreatmentTreatmentofconsumptivecoagulopathySupplementofcoagulationfactors:freshblood,frozenbloodplasma,fibrinogen,bloodplatelet.Heparin:highcoagula
8、tionAnti-fibrinolysisPreventionofrenalfailureThankyou!!假如你是大夫...例:孕37周阴道三次较多量无痛性出血,来诊?例:孕30周+4天,曾阴道无痛出血两次,咨询?PLACENTAPREVIA前置胎盘李爱斌正常胎盘附着位置
