Download - 胎盘早剥
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胎盘早剥
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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
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Etiology
• Vascular injury
PIH syndrome
chronic renal disease• mechanical factors
twins
polyhydramnios
short umbilical cord• suddenly rising of the uterus venous pressure
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Pathophysiology
• The hemorrhage in the decidua
• forming hematoma behind placenta
• separate from wall of the uterus
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Classification
• A revealed abruption
• B concealed abruption
• C mixed hemorrhage
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显性出血
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隐性出血
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混和性出血
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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。
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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。
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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
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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
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Assistant examination
• B-ultrasound examination
• laboratory findings
A the degree of anemia
B funtion of coagulation
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Diagnosis
• History
• signs
• examination
• assistant examination
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Differential diagnosis
• Placenta previa
• impending rupture of uterus
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Complications
• DIC and dysfunction clotting
• postpartum hemorrhage
• acute renal failure
• Sheehan, s syndrome
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Prevention
• Improving prenatal care
• improving treatment for high
risk pregnancy
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Trestment⑴
• Correct shock
• terminating pregnancy
A vaginal delivery
B cesaerean section
• Preventing postpartum
hemorrhage
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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