妇产科教学课件：产前及产后出血
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4.Fibrinogen and the majority of procoagulant blood factors (I, VII, VIII, IX, and X) increase during pregnancy.
产前及产后出血---概论
关于产后出血量的统计： 美国统计：阴道分娩平均500ml(50%>500ml), 剖宫产1000ml，急诊子宫切除术3500ml，严重 的出血（HCT降10%或需输血）约为阴道分娩中 的4%，剖宫产中6%。 我国产后出血治疗组的统计,阴道分娩失血量24小 时为398±238ml,36%的正常阴道分娩≥400ml, 剖宫产475.3±263.2ml。 WHO产后出血技术小组提出：靠临床估计和测 量比实际失血量低估30-50%。
The overall reported incidence of placenta previa at delivery is 4/1,000 deliveries.
产前及产后出血---前置胎盘
（ placenta previa ）
病因及高危因素： Increasing parity Increasing maternal age Cigarette smoking Residence in higher altitude Multiple gestations Previous placenta previa Prior curettage Prior cesarean delivery: In the pregnancy following a cesarean delivery, the risk of placenta previa has been reported to be between 1 and 4 percent. In patients with four or more cesarean deliveries, the risk of placenta previa approaches 10 percent.
Class 2 hemorrhage:1,200- to 1,500-ml blood loss （20%- 25%）.Tachycardia, tachypnea, narrowed pulse pressure, orthostatic hypotension, delayed hypothenar refilling
Class 3 hemorrhage: 1,800 to 2,100 ml (30% to 35%). Worsening tachycardia (120 to 160 beats/minute), tachypnea (30 to 50 breaths/minute), overt hypotension, and cool extremities.
产前及产后出血---概论
机体为适应产时生理性失血的生理性改变： 1.The average singleton pregnancy has a 40- to 50-percent increase in plasma volume, which occurs by the 30th week of gestation.
产前及产后出血
Antepartum and Postpartum Hemorrhage
产前及产后出血---概论
产前和产后出血是孕产妇死亡的首位原因。 Antepartum and postpartum hemorrhage remain one of the leading causes of obstetric morbidity and mortality throughout the world. Between 17 and 25 percent of all pregnancy-related deaths can be directly attributed to hemorrhage. 我国统计，占40%-50%的孕产妇死亡原因
Traditionally three variations of placenta previa are recognized: complete, partial, and marginal.
Contemporary classification of placenta previa consists of two variations: placenta previa, in which the cervical os is covered by placental tissue, and marginal placenta previa, in which the placenta lies within 2 to 3 cm of the cervical os but does not cover it. 孕28周后诊断？孕28周前诊断前置胎盘状态？ 发生率：
Class 4 hemorrhage: more than a 2,400-ml blood loss (40%). Shock, oliguria/anuria
产前及产后出血---原因
1、产前——流产、异位妊娠、胎盘疾病（前置胎 盘、胎盘早剥、边缘血窦破裂、前置血管破 裂）、子宫破裂、宫颈阴道病变、血液病等内科 疾病。 2、产后——
①早期（24小时内）子宫迟缓、胎盘组织残留 或粘连植入、产道损伤、DIC、子宫破裂、血液 病等内科疾病。
② 晚期（24小时—42天）： 子宫复旧不良、胎膜胎盘残留、副胎盘、会阴伤 口感染裂开、剖宫产子宫切口感染裂开等。
产前及产后出血---前置胎盘
（ placenta previa ）
定义：
Placenta previa is defined as the presence of placental tissue over or adjacent to the cervical os.
2.Red blood cell mass can be expected to increase 20 to 30 percent by the end of pregnancy.
3.Cardiac output is 30 to 50 percent above nonpregnant levels.
产前及产后出血---概论
产科出血的定义： 我国产后出血的定义：500ml。 美国等：按失血量的比例定义。
The average 60-kg pregnant woman maintains a blood volume of 6,000 ml by 30 weeBiblioteka Baidus' gestation. Class 1 hemorrhage：900-ml blood loss（15%）. Asymptomatic.
产前及产后出血---概论
关于产后出血量的统计： 美国统计：阴道分娩平均500ml(50%>500ml), 剖宫产1000ml，急诊子宫切除术3500ml，严重 的出血（HCT降10%或需输血）约为阴道分娩中 的4%，剖宫产中6%。 我国产后出血治疗组的统计,阴道分娩失血量24小 时为398±238ml,36%的正常阴道分娩≥400ml, 剖宫产475.3±263.2ml。 WHO产后出血技术小组提出：靠临床估计和测 量比实际失血量低估30-50%。
The overall reported incidence of placenta previa at delivery is 4/1,000 deliveries.
产前及产后出血---前置胎盘
（ placenta previa ）
病因及高危因素： Increasing parity Increasing maternal age Cigarette smoking Residence in higher altitude Multiple gestations Previous placenta previa Prior curettage Prior cesarean delivery: In the pregnancy following a cesarean delivery, the risk of placenta previa has been reported to be between 1 and 4 percent. In patients with four or more cesarean deliveries, the risk of placenta previa approaches 10 percent.
Class 2 hemorrhage:1,200- to 1,500-ml blood loss （20%- 25%）.Tachycardia, tachypnea, narrowed pulse pressure, orthostatic hypotension, delayed hypothenar refilling
Class 3 hemorrhage: 1,800 to 2,100 ml (30% to 35%). Worsening tachycardia (120 to 160 beats/minute), tachypnea (30 to 50 breaths/minute), overt hypotension, and cool extremities.
产前及产后出血---概论
机体为适应产时生理性失血的生理性改变： 1.The average singleton pregnancy has a 40- to 50-percent increase in plasma volume, which occurs by the 30th week of gestation.
产前及产后出血
Antepartum and Postpartum Hemorrhage
产前及产后出血---概论
产前和产后出血是孕产妇死亡的首位原因。 Antepartum and postpartum hemorrhage remain one of the leading causes of obstetric morbidity and mortality throughout the world. Between 17 and 25 percent of all pregnancy-related deaths can be directly attributed to hemorrhage. 我国统计，占40%-50%的孕产妇死亡原因
Traditionally three variations of placenta previa are recognized: complete, partial, and marginal.
Contemporary classification of placenta previa consists of two variations: placenta previa, in which the cervical os is covered by placental tissue, and marginal placenta previa, in which the placenta lies within 2 to 3 cm of the cervical os but does not cover it. 孕28周后诊断？孕28周前诊断前置胎盘状态？ 发生率：
Class 4 hemorrhage: more than a 2,400-ml blood loss (40%). Shock, oliguria/anuria
产前及产后出血---原因
1、产前——流产、异位妊娠、胎盘疾病（前置胎 盘、胎盘早剥、边缘血窦破裂、前置血管破 裂）、子宫破裂、宫颈阴道病变、血液病等内科 疾病。 2、产后——
①早期（24小时内）子宫迟缓、胎盘组织残留 或粘连植入、产道损伤、DIC、子宫破裂、血液 病等内科疾病。
② 晚期（24小时—42天）： 子宫复旧不良、胎膜胎盘残留、副胎盘、会阴伤 口感染裂开、剖宫产子宫切口感染裂开等。
产前及产后出血---前置胎盘
（ placenta previa ）
定义：
Placenta previa is defined as the presence of placental tissue over or adjacent to the cervical os.
2.Red blood cell mass can be expected to increase 20 to 30 percent by the end of pregnancy.
3.Cardiac output is 30 to 50 percent above nonpregnant levels.
产前及产后出血---概论
产科出血的定义： 我国产后出血的定义：500ml。 美国等：按失血量的比例定义。
The average 60-kg pregnant woman maintains a blood volume of 6,000 ml by 30 weeBiblioteka Baidus' gestation. Class 1 hemorrhage：900-ml blood loss（15%）. Asymptomatic.