产科出血精品医学ppt课件

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1、ObstetricalHemorrhage产科出血概述◆Obstetricsis“bloodybusiness”◆定义(Definitionsofobstetricalhemorrhage):目前尚缺乏明确及统一的界定►Hematocritdropof10volumepercent►Needfortransfusion概述◆美国CDC资料显示:在非流产相关(nonabortion-relatedmaternaldeaths)的孕妇死亡中,出血约占30%◆产科出血率也与社会,种族,经济等因素有关◆Hemorrhagema

2、ybeantepartumorpostpartum.Hemorrhageisadescriptionofanevent,andnotadiagnosis.◆Becauseofinexactdefinitionsused,theincidenceofobstetricalHemorrhagecannotbedeterminedpreciselyWilliamsObstetrics(21stedition)概述导致产科出血的主要病变分类◆产前出血(antepartumhemorrhage)◆产后出血(postpartumh

3、emorrhage)◆消耗性血凝异常(consumptivecoagulopathy)概述导致产科出血的主要病变----产前出血►胎盘早剥(placentalabruption)►前置胎盘(placentaprevia)概述导致产科出血的主要病变----产后出血►子宫收缩乏力(uterineatony)►胎盘残留(retainedplacentalfragments)►其他胎盘因素►生殖道裂伤(genitaltractlacerations)►产后血肿(puerperalhematomas)►子宫破裂(ruptureo

4、ftheuterus)概述导致产科出血的主要病变----血凝异常►胎盘早剥►羊水栓塞(Amnionicfluidembolism)►败血症(Septicemia)►流产(Abortion)►FetaldeathanddelayeddeliveryTable1:Causesof764pregnancy-relateddeathsduetohemorrhageCauseofhemorrhageNumber(%)Abruptioplacentae141(19)Laceration/uterinerupture125(16)U

5、terineatony115(15)Coagulopathies108(14)Placentafactors76(10)Placentaprevia50(7)Uterinebleeding47(6)Formchichakilandcolleagues.USA,CDC,1999产科出血的高危因素◆胎盘形成异常(Abnormalplacentation)◆分娩时损伤(Traumaduringlaboranddelivery)◆孕妇血容量少(Smallmatermalbloodvolume)◆子宫收缩乏力(Uterineat

6、ony)◆血凝异常(Coagulationdefects)◆其他因素(Otherfactors):肥胖,既往有产后出血史种族因素产科出血的高危因素胎盘形成异常(Abnormalplacentation)◆Placentaprevia◆Placentalabruption◆Placentalaccreta/increta/percreta◆Etopicpregnancy◆Hydatidiformmole产科出血的高危因素分娩时损伤(Traumaduringlaboranddelivery)◆会阴切开术(Episiotom

7、y)◆Complicatedvaginaldelivery◆Low-ormid-forcepsdelivery◆Cesareandeliveryorhysterectomy◆HighrisksofUterinerupture:PreviouslyscarreduterusHyperstimulationObstructedlaborIntrauterinemanipulationMidforcepsrotation产科出血的高危因素孕妇血容量少(Smallmatermalbloodvolume)◆Smallwomen◆

8、Pregnancyhypervolemianotyetmaximal◆PregnancyhypervolemiaconstrictedSeverepreeclampsiaEclampsia产科出血的高危因素子宫收缩乏力(Uterineatony)◆Overdiatenteduterus:largefetusmutiplefetus