产科出血.ppt
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◆ Previous uterine atony
产科出血的高危因素
血凝异常 (Coagulation defects)
◆ Placental abruption ◆ Prolonged retention of dead fetus ◆ Amnionic fluid embolism ◆ Sepsis with endotoxemia ◆ Severe intravascular hemolysis ◆ Massive transfusion ◆ Severe preeclampsia and eclampsia ◆ Congenital coagulopathies ◆ Anticoagulant treatment
种族因素
产科出血的高危因素
胎盘形成异常 (Abnormal placentation) ◆ Placenta previa ◆ Placental abruption ◆ Placental accreta / increta /percreta ◆ Etopic pregnancy ◆ Hydatidiform mole
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 (Amnionic fluid embolism) ►败血症 (Septicemia) ►流产 (Abortion) ► Fetal death and delayed delivery
Table 1: Causes of 764 pregnancy-related deaths due to hemorrhage
◆ Because of inexact definitions used, the incidence of obstetrical Hemorrhage cannot be determined precisely
Williams Obstetrics ( 21st edition )
概述
导致产科出血的主要病变分类 ◆产前出血 (antepartum hemorrhage) ◆产后出血 ( postpartum hemorrhage) ◆消耗性血凝异常 (consumptive coagulopathy)
◆ Overdiatented uterus : large fetus mutiple fetuses hydramnios
◆ Anesthesia or analgesia
◆ Exhausted myometrium : rapid labor prolonged labor oxytocin or prostaglandin stimulation
概述
导致产科出血的主要病变----产前出血 ►胎盘早剥 (placental abruption) ►前置胎盘 (placenta previa)
Hale Waihona Puke Baidu述
导致产科出血的主要病变----产后出血
►子宫收缩乏力 (uterine atony) ►胎盘残留 (retained placental fragments) ►其他胎盘因素 ►生殖道裂伤 (genital tract lacerations) ►产后血肿 (puerperal hematomas) ►子宫破裂 (rupture of the uterus)
Cause of hemorrhage
Number (%)
Abruptio placentae Laceration / uterine rupture Uterine atony Coagulopathies Placenta factors Placenta previa Uterine bleeding
◆ High risks of Uterine rupture:
Previously scarred uterus Hyperstimulation
Obstructed labor
Intrauterine manipulation
Midforceps rotation
产科出血的高危因素
孕妇血容量少 (Small matermal blood volume)
概述
◆美国CDC资料显示: 在非流产相关(nonabortion-related maternal deaths)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
◆ Hemorrhage may be antepartum or postpartum. Hemorrhage is a description of an event, and not a diagnosis.
Obstetrical Hemorrhage 产科出血
概述
◆ Obstetrics is “bloody business”
◆定义 ( Definitions of obstetrical hemorrhage): 目前尚缺乏明确及统一的界定 ►Hematocrit drop of 10 volume percent ► Need for transfusion
141 (19) 125 (16) 115 (15) 108 (14) 76 (10) 50 (7) 47 (6)
Form chichakil and colleagues .USA ,CDC,1999
产科出血的高危因素
◆胎盘形成异常 (Abnormal placentation) ◆分娩时损伤 (Trauma during labor and delivery) ◆孕妇血容量少 (Small matermal blood volume) ◆子宫收缩乏力 (Uterine atony) ◆血凝异常 (Coagulation defects) ◆其他因素 (Other factors): 肥胖, 既往有产后出血史
产科出血的高危因素
分娩时损伤 (Trauma during labor and delivery)
◆ 会阴切开术 (Episiotomy)
◆ Complicated vaginal delivery
◆ Low-or mid-forceps delivery
◆ Cesarean delivery or hysterectomy
◆ Small women
◆ Pregnancy hypervolemia not yet maximal
◆ Pregnancy hypervolemia constricted Severe preeclampsia Eclampsia
产科出血的高危因素
子宫收缩乏力 (Uterine atony)
产科出血的高危因素
血凝异常 (Coagulation defects)
◆ Placental abruption ◆ Prolonged retention of dead fetus ◆ Amnionic fluid embolism ◆ Sepsis with endotoxemia ◆ Severe intravascular hemolysis ◆ Massive transfusion ◆ Severe preeclampsia and eclampsia ◆ Congenital coagulopathies ◆ Anticoagulant treatment
种族因素
产科出血的高危因素
胎盘形成异常 (Abnormal placentation) ◆ Placenta previa ◆ Placental abruption ◆ Placental accreta / increta /percreta ◆ Etopic pregnancy ◆ Hydatidiform mole
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 (Amnionic fluid embolism) ►败血症 (Septicemia) ►流产 (Abortion) ► Fetal death and delayed delivery
Table 1: Causes of 764 pregnancy-related deaths due to hemorrhage
◆ Because of inexact definitions used, the incidence of obstetrical Hemorrhage cannot be determined precisely
Williams Obstetrics ( 21st edition )
概述
导致产科出血的主要病变分类 ◆产前出血 (antepartum hemorrhage) ◆产后出血 ( postpartum hemorrhage) ◆消耗性血凝异常 (consumptive coagulopathy)
◆ Overdiatented uterus : large fetus mutiple fetuses hydramnios
◆ Anesthesia or analgesia
◆ Exhausted myometrium : rapid labor prolonged labor oxytocin or prostaglandin stimulation
概述
导致产科出血的主要病变----产前出血 ►胎盘早剥 (placental abruption) ►前置胎盘 (placenta previa)
Hale Waihona Puke Baidu述
导致产科出血的主要病变----产后出血
►子宫收缩乏力 (uterine atony) ►胎盘残留 (retained placental fragments) ►其他胎盘因素 ►生殖道裂伤 (genital tract lacerations) ►产后血肿 (puerperal hematomas) ►子宫破裂 (rupture of the uterus)
Cause of hemorrhage
Number (%)
Abruptio placentae Laceration / uterine rupture Uterine atony Coagulopathies Placenta factors Placenta previa Uterine bleeding
◆ High risks of Uterine rupture:
Previously scarred uterus Hyperstimulation
Obstructed labor
Intrauterine manipulation
Midforceps rotation
产科出血的高危因素
孕妇血容量少 (Small matermal blood volume)
概述
◆美国CDC资料显示: 在非流产相关(nonabortion-related maternal deaths)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
◆ Hemorrhage may be antepartum or postpartum. Hemorrhage is a description of an event, and not a diagnosis.
Obstetrical Hemorrhage 产科出血
概述
◆ Obstetrics is “bloody business”
◆定义 ( Definitions of obstetrical hemorrhage): 目前尚缺乏明确及统一的界定 ►Hematocrit drop of 10 volume percent ► Need for transfusion
141 (19) 125 (16) 115 (15) 108 (14) 76 (10) 50 (7) 47 (6)
Form chichakil and colleagues .USA ,CDC,1999
产科出血的高危因素
◆胎盘形成异常 (Abnormal placentation) ◆分娩时损伤 (Trauma during labor and delivery) ◆孕妇血容量少 (Small matermal blood volume) ◆子宫收缩乏力 (Uterine atony) ◆血凝异常 (Coagulation defects) ◆其他因素 (Other factors): 肥胖, 既往有产后出血史
产科出血的高危因素
分娩时损伤 (Trauma during labor and delivery)
◆ 会阴切开术 (Episiotomy)
◆ Complicated vaginal delivery
◆ Low-or mid-forceps delivery
◆ Cesarean delivery or hysterectomy
◆ Small women
◆ Pregnancy hypervolemia not yet maximal
◆ Pregnancy hypervolemia constricted Severe preeclampsia Eclampsia
产科出血的高危因素
子宫收缩乏力 (Uterine atony)