妇产科学早产课件

早产的治疗
治疗原则：
• 若胎儿存活、无明显畸形、无胎儿窘迫、胎膜未破， 无严重妊娠合并症及并发症、宫口开大2cm以下、 应设法抑制宫缩延长孕周。
• 若胎膜已破，早产已不可避免时，应尽力设法提高 早产儿的存活率。
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病因分析常用方法
• B超检查
• 阴道窥器检查及阴道流液涂片：找羊水结 晶，了解有无胎膜早破
• 宫颈及阴道分泌物培养 • 羊膜穿刺
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抑制宫缩
• β-受体激动剂：利托君（安宝）、 沙丁胺醇（硫酸舒喘灵）
• 硫酸镁 • 钙离子阻滞剂 • 前列腺素合成酶抑制剂
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
治疗方法
一般处理
– 卧床休息 – 补液治疗 – 心理治疗
抑制宫缩
促胎儿肺成熟
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宫颈检查
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美国早产儿实际发生的比例 1990 - 2004
12 10.6
10
8
6
4
2
0 1990
11 1993
12.3
12.5
11
11.4
11.8
11.6
ቤተ መጻሕፍቲ ባይዱ
1995
1997
1999
2000
2003
2004
Hoyert DL, et al Pediatrics 2006 Jan ;117 (1):168-83.
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早产的病因学
①胎膜早破、绒毛膜羊膜炎 ②下生殖道及泌尿道感染 ③妊娠合并症与并发症: 如妊娠期高血压疾病、妊娠期肝内胆
汁淤积症、妊娠合并心脏病、慢性肾炎
④子宫膨胀过度及胎盘因素：如羊水过多、多胎妊娠、前置
胎盘、胎盘早剥等
⑤子宫畸形：如纵隔子宫、双角子宫等 ⑥宫颈内口松弛
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宫颈长度评估
超声检测宫颈长度：对早产预测很有价值
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早产的流行病学
• 多胎儿的发生 : 18.9 /1000 出生比 1980 31.5/1000出生比 2003 (3.3% of total births) Hovert et al., 2006
• 超过半数的双胞胎(54%) 和超过90% 的多胎生育是早产 儿, 约9.6% 的单胎是早产儿. Gardner et al., 1995
沙丁胺醇
• 以往国内最常用 • 2.4mg-4.8mg,q6-8h,po • 宫缩消失后停药 • 药物说明书注明孕妇慎用，故现使用较少
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早产的临床表现
可有晚期流产、早产及产伤史，此次妊娠 满28周后至37周前出现较规则宫缩（间隔56min，持续≧ 30秒）
肛查：宫颈管消失，宫口扩张
部分可伴有少量阴道流血或流水
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Ritodrine (利托君，安宝）
• 1980年美国FDA批准治疗早产 • 用法：先静脉给药：ivgtt
安宝100mg+5%GS 500ml，5-10滴/分开始， 10分钟增加5滴/分，最大滴数不超过35滴/分， 宫缩完全抑制后继续静滴12-18h,
后改为口服（静滴结束前1/2h） 安宝片10mg q2h х 1天以后1#/4-6h， 每日总量不超过12# • 注意事项：心电监护，HR<130次/分
胎儿纤维连接蛋白 fetal fibronectin, fFN
• 原理
– 绒毛膜胎膜表面的特异性蛋白，早产时绒毛 膜的蛋白水解酶的活性增强，fFN外溢，进入 宫颈阴道的分泌物中
• 阴道后穹隆棉拭子检测 fFN>50ng/ml
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硫酸镁
• 机制：直接作用子宫肌细胞，拮抗钙离子对子 宫收缩活性
• 用法：
– 25%MgSO4 30ml+5%GS500ml,ivgtt
– 1.5-2.0g/h – 总量<20g • 注意事项
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This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
早产的预测
• 高危因素分析 • 宫颈评估 • 超声检查 • 宫颈阴道分泌物检查
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This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
早产 preterm labor
温州医学院附属第一医院妇产科 周美茜
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早产的定义
妊娠满28周至不满37足周(196～258日)间分娩 者称早产(preterm labor,PTL) 。此时娩出的新 生儿称早产儿(premature infant)，出生体重为 1000～2499g，各器官发育尚不够成熟。
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
早产的流行病学
• 每年有超过400,000因为早产和其他妊娠原因的 早产儿出生，占分娩总数5-15%.
• 早产是婴儿死亡的首要原因. 并发症： 呼吸窘迫综合征、坏死性结肠炎、高胆红素血 症、脑室内出血、动脉导管未闭、视网膜病变、 脑瘫等.
• 早产引发婴儿疾病,死亡, 与大量社会公共费用与 人力的投入.
早产的诊断
几个概念区分：
• Braxton-Hick’s宫缩 • 先兆早产
妊娠满28周小于37周的孕期, 伴有规律性宫缩 (通常 20分钟内至少4次或60分钟内至少8次) 和宫颈进行 性扩张2 cm以上及 宫颈管缩短≧75% , 既可诊断为
早产临产
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