胎盘早期剥离课件.ppt

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1、PlacentalAbruptionZongjunHaoDepartmentofOb&GyTaianpublicHealthSchoolofShandongProvince胎盘早期剥离2021/8/151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60/40mmHg，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C2021/8/152

2、难点DifficultpointsPathologyofplacentalabruption.胎盘早剥的病理Etiology、ClinicalchracateristicandTreatment病因和治疗原则重点emphasis学习目标sdudyingAimsGraspthedefinition、Etiology、Pathology、Clinicalchracateristicandpriciplesofplacentalabruption.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2021/8/153

3、GeneralConsiderationperinatalmorbidity发病率0.46%-2.1%(ourcountry)1%(othercountries）perinatalmortality死亡率20%-35%Definition定义Theseparationoftheplacentafromitssiteofimplantationafter20weeksofgestationorduringthecourseofdelivery.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。2021

4、/8/154Etiology病因Riskfactors1、Vasculardiseases:血管疾病preeclampsia,chronichypertension,renaldisease.先兆子痫、慢性高血压、慢性肾病等2、Mechanicalfactors:机械性损伤trauma,intercourseetc.外伤、性生活、外倒转术纠正胎位等2021/8/155Etiology病因Riskfactors3、Supinehypotensivesyndrome仰卧位低血压综合征4、reducingofuterine

5、presuresuddenly宫腔内压力骤降multiplegestaion,hytramniosetc.5、others:其它shortumbilicalcordetc.脐带过短、绕颈等2021/8/156PathologyMainchange主要病理改变hemorrhageofthedeciduabasalis底蜕膜出血2021/8/157Pathologychangehemorrhageofthedeciduabasalis底蜕膜螺旋动脉破裂出血→deciduasplits底蜕膜分离→deciduralhema

6、toma底蜕膜血肿→separation,compression,destructionoftheplacentaadjacenttoit剥离、出血、挤压、剥离→恶性循环2021/8/158PathologyTypes分类revealedabruption显性剥离concealedabruption隐性剥离mixedabruption混合剥离2021/8/159ClinicalchracteristicsSudden，continuousabdominalpain突然的、持续的腹痛Vaginalbleeding阴道出

7、血2021/8/1510Uteroplacentalapoplexy子宫胎盘卒中Hypovolemicshock低血容量性休克Amnioticfluidembolism羊水栓塞Acuterenalfailure急性肾功能衰竭Postpartumhemorrhage产后出血DIC弥漫性血管内凝血Complication并发症2021/8/1511TreatmentTreatmentofhypovolemicshock:抗休克intensivetransfusionwithbloodTerminationofpregna

8、ncy尽快终止妊娠promptly:CesareanorVaginaldeliveryControlcomplications：控制并发症2021/8/1512初孕妇，29岁，妊娠35周，以往无高血压病史，近一周来血压160~170/100~110mmHg，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？homework2