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ID:41535507
大小:1.54 MB
页数:44页
时间:2019-08-27
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1、PlacetalPreviaLongXiaoyu龙晓宇XuanWuHospital宣武医院Case1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase1Whatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementoft
2、hispatient?WhatarethemostcommoncausesofAntepartumHemorrhage?COMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselruptureCervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorderU
3、nknown(byexclusionoftheabove)PlacentalPreviaUnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationO
4、bjectivesDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal:0.24%~1.57%;International:0.5%~0.9%。PlacentalPrevia“theplacentaoverlyingtheinternalosofthecervix”ClassificationClassifica
5、tionComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentapreviaWhataretheriskfactorsforplacentalPrevia?QuestionETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbort
6、ions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGYManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentationManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperio
7、dandthevolumeoflosingblood.TotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentapreviaBetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentapreviaBetweentotalandmarginalMarginalplacentapr
8、eviaLate(37-40WKSorinlabor)LessbleedingsymptomSeverebloodlosingleadstoseveralshocksigns,suchaspaleness,weakand
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