胎盘早剥

Definition

After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption

Etiology

• Vascular injury

PIH syndrome

chronic renal disease• mechanical factors

twins

polyhydramnios

short umbilical cord• suddenly rising of the uterus venous pressure

Pathophysiology

• The hemorrhage in the decidua

• forming hematoma behind placenta

• separate from wall of the uterus

Classification

• A revealed abruption

• B concealed abruption

• C mixed hemorrhage

显性出血

隐性出血

混和性出血

病 例 王铭，女， 27 岁，以“停经九个月，胎动五个月，突发性下腹痛

伴阴道流血一小时”为主诉入院。平素月经规律，早孕 反应不明显，孕 18 周觉胎动，活跃至今，一小时前无明显诱因突发下腹痛，阴道 少量流血，鲜红，无意识模糊等表现。

查体： T37.2℃， P21 次 / 分， BP85/55mmHg ，心肺听诊无异常，腹 膨隆，孕足月腹， 纵产式腹肌紧张，子宫易激惹，右下腹有一局限性压痛点，阴道流血少量。

实验室检查：血常 RBC2OO×1012/L ， HGB8.7g/L,WBC11

.4×109。

辅助检查： B 超示 BPD9.5cm ， FL7.4 cm, 胎盘位于后壁，与子宫间见一个 3× 5cm 低回声区，未见胎心反射。

Clinical manifestationsMild type

during labor

revealed abruption

＜ 1/3 in size

vaginal bleeding

slight abdominal pain

uterus is soft

fetal position is clear

fetal heart sounds is clear

Severe type PIH symptoms concealed or mixed abruption ＞ 1/3 in size a lot of blood uterus enlarged rapidly increasing pain pallor out of proportion to amount of vaginal

bleeding fetal position is not clear fetal heart sound disappear

Clinical manifestations

Assistant examination

• B-ultrasound examination

• laboratory findings

A the degree of anemia

B funtion of coagulation

Diagnosis

• History

• signs

• examination

• assistant examination

Differential diagnosis

• Placenta previa

• impending rupture of uterus

Complications

• DIC and dysfunction clotting

• postpartum hemorrhage

• acute renal failure

• Sheehan, s syndrome

Prevention

• Improving prenatal care

• improving treatment for high

risk pregnancy

Trestment⑴

• Correct shock

• terminating pregnancy

A vaginal delivery

B cesaerean section

• Preventing postpartum

hemorrhage

Treatment⑵

• Treating the dysfunctional clotting

A transfusing fresh blood

B transfusing fibrinogen （纤维蛋白原） C transfusing fresh plasma

D use of heparin （肝素） E anti-fibrinogenolysis agent （抗纤溶剂）

• preventing failure of renal function urine volume ＜ 30ml/h 补充血容量 ＜ 17ml/h 肾衰