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1、Placental AbruptionZongjun Hao Department of Ob & GyTaian public Health School of Shandong Province胎盘早期剥离 孕妇，30岁，G1P0 ，36周妊娠，2h前腹部受外伤后出现持续性腹痛而入院。检查：孕妇面色苍白，血压60/40 mmHg，胎心率100次/min，子宫底位于剑突下2横 指，子宫压痛，张力高。正确处理方法为：A、给予镇静止痛剂B、纠正休克后继续妊娠 C、纠正休克，同时行剖宫产术 D、应用子宫收缩抑制剂病例C难点Difficult pointsPathology of placental
2、 abruption.胎盘早剥的病理 Etiology 、 Clinical chracateristic and Treatment病因和治疗原则重 点emphasis学习目标sdudying Aims Grasp the definition 、 Etiology 、Pathology 、Clinical chracateristic and priciples of placental abruption. 掌握胎盘早剥的定义、 发病原因、 病理及其临床特点和治疗原则General Considerationperinatal morbidity发病率发病率 0.46%-2.1% (ou
3、r country) 1% (other countries）perinatal mortality死亡率死亡率 20%-35%Definition 定义 The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. 妊娠20周后或在分娩期发生正常位置的胎盘发生部分或全部从子宫壁剥离。Etiology 病因病因 Risk factors1、Vascular diseases: 血管疾病血管疾病 preeclamp
4、sia, chronic hypertension, renal disease. 先兆子痫、慢性高血压、慢性肾病等先兆子痫、慢性高血压、慢性肾病等2、Mechanical factors: 机械性损伤机械性损伤 trauma, intercourse etc. 外伤外伤 、性生活、性生活 、外倒转术纠正胎位等外倒转术纠正胎位等Etiology 病因病因 Risk factors3、Supine hypotensive syndrome 仰卧位低血压综合征仰卧位低血压综合征4、reducing of uterine presure suddenly 宫腔内压力骤降宫腔内压力骤降 multipl
5、e gestaion, hytramnios etc.5、others:其它其它 short umbilical cord etc. 脐带过短、绕颈等脐带过短、绕颈等PathologyMain change 主要病理改变主要病理改变 hemorrhage of the decidua basalis 底蜕膜出血底蜕膜出血Pathology change hemorrhage of the decidua basalis 底蜕膜螺旋动脉破裂出血 decidua splits 底蜕膜分离 decidural hematoma 底蜕膜血肿 separation, compression, destr
6、uction of the placenta adjacent to it 剥离、出血、挤压、剥离恶性循环PathologyTypes分类 revealed abruption 显性剥离 concealed abruption 隐性剥离 mixed abruption 混合剥离Clinical chracteristics Sudden ， continuous abdominal pain 突然的、持续的腹痛突然的、持续的腹痛Vaginal bleeding 阴道出血Uteroplacental apoplexy 子宫胎盘卒中子宫胎盘卒中Hypovolemic shock 低血容量性休克低血
7、容量性休克Amniotic fluid embolism 羊水栓塞羊水栓塞Acute renal failure 急性肾功能衰竭急性肾功能衰竭Postpartum hemorrhage 产后出血产后出血DIC 弥漫性血管内凝血弥漫性血管内凝血Complication并发并发症症TreatmentTreatment of hypovolemic shock: 抗休抗休克克 intensive transfusion with bloodTermination of pregnancy 尽快终止妊娠 promptly : Cesarean or Vaginal deliveryControl complications： 控制并发症 初孕妇，29岁，妊娠35周，以往无高血压病 史，近一周来血压160170/100110mmHg，现因下腹痛3h伴阴道流血入院，如果你是接诊护士，你首先想到是什么疾病？homeworkThank you !Thank you !Pathology 1revealed abruption 显性出血Pathology 2concealed abruption 隐性出血Pathology 3mixed abruption 混合性出血
