_previa前置胎盘课件

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1、IfyouareadoctorInthemidnight,thepregnantwomenawakenstofindthattheyhavetosleepinapoolofbloodHowtodiagnosis？Howtomanagement？YouAntepartumHemorrhageObstetrics&GynecologyHospitalofFudanUniversityXuHuanRationale(whywecare…)4-5%ofpregnanciescomplicatedby3rdtrimesterbleedingImmediateevaluationneededS

2、ignificantthreattomother&fetus(considerphysiologicincreaseinuterinebloodflow)Considercausesofmaternal&fetaldeathPrioritiesinmanagement(triage!)ObjectivesWewillbeableto:Describetheapproachtothepatientwiththird-trimesterbleedingComparesymptoms,physicalfindings,anddiagnosticmethodsthatdifferentia

3、tebleedingetiologiesDescribemanagementanddeliveryoptionsfor3rdtrimesterbleedingetiologiesDescribepotentialmaternalandfetalmorbidity&mortalityDescribemanagementofpostpartumhemorrhageApplyknowledgeinthediscussionofclinicalcasescenariosVaginalBleeding:DifferentialdiagnosisCommon:Abruption,previa,

4、pretermlabor,laborLesscommon:Uterinerupture,fetalvesselrupture,lacerations/lesions,cervicalectropion,polyps,vasaprevia,bleedingdisordersUnknownNOTvaginalbleeding!!!(happensmorethanyouthink!)OtherEtiologiesCervicitisinfectionCervicalerosionTraumaCervicalcancerForeignbodyBloodyshow/laborPerinata

5、lmortalityandmorbidityPreviaDecreasedmortalityfrom30%to1%overlast60yearsNowemergentcesareandeliveryoftenpossibleRiskofpretermdeliveryAbruptionPerinatalmortalityrate35%Accountsfor15%of3rdtrimesterstillbirthsRiskofpretermdeliveryMostcommoncauseofDICinpregnancyMassivehemorrhage-->riskofacuterenal

6、failure,Sheehan’s,etc.PlacentapreviaDefinitionAfter28pregnantweeksplacentalimplantationoverthecervicalosorintheloweruterinesegmentItconstitutesanobstructionofdescentofthepresentingpartMaincauseofobstetricalhemorrhage(20%)Incidence0.24%-1.57%(ourcountry).RiskfactorsPriorcesareandelivery/myomect

7、omyPriorprevia(4-8%recurrencerisk)PreviousabortionIncreasedparityMultiplepregnancyAdvancedmaternalageAbnormalpresentationSmokingEtiologyCausesEndometrialabnormalityScaredorpoorlyvascularizedendometriuminthecorpus.Curettage,Delivery,CSan