产后出血2010（北医三院八年制临床医学课件）

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1、“ObstetricsisBloodyBusiness”*PostpartumHemorrhage:*Cunningham,et.al:WilliamsObstetrics,21sted.,2001PPHistheleadingcauseofdeathrelatedtopregnancyworldwide…1Majorcausesofdeathforpregnancywomen（maternalmortality)Postpartumhemorrhage（28%)heartdiseasespregnancy-inducedhypertension(orAmnioticfluidemboli

2、sm)infection2DefinitionofPPHTheearlyPPHisdefinedasabloodlossexceeding500mlafterdeliveryoftheinfant<24hThelatePPH:occursafter24hourofdeliveryto6weeks3MajorcausesUterineatony(90%)Lacerationsofthegenitaltract(6%)Retainedplacenta(3%-4%)Coagulationdefects(blooddyscrasia)(4T:tone,tissue,trauma,thrombin)

3、Etiology/prediction/prevention/management41.UterineatonyLocalfactors:OverdistentionoftheuterineConditionthatinterferewithcontraction(leiomyoma)Complications(PIH,anemia,placentaprevia)Systemicfactors:NervousDrugsAbnormallaborHistoryofpreviousPPHPreeclampsia,abnormalplacentationEtiology/prediction/p

4、revention/management5PathologyContractionconstrictingthespiralarteriesPreventingtheexcessivebleedingfromtheplacentaimplantationsiteUterineatonygiverisetoPPHwhennocontractionoccurEtiology/prediction/prevention/management6MaincomplainHaveheartpalpitationsFeelfaintLightheadedBreathless…Etiology/predi

5、ction/prevention/management72.LacerationsofthegenitaltractCauses:Instrumenteddelivery(forceps)manipulativedelivery(breechextraction,precipitouslabor,macrosomia)Types:perineumlacerationvaginallacerationcervicallacerationEtiology/prediction/prevention/management83.RetainedplacentaSeparationandexplos

6、ionofplacentaiscausedbystronguterinecontractionPlacentatissueremainingintheuteruspreventadequatecontractionandpredisposetoexcessivebleedingEtiology/prediction/prevention/management94.CoagulationdefectsAcquiredabnormalityinbloodclotting:abruptionplacenta,amnioticfluidembolismseverepreeclampsiaConge

7、nitalabnormalityinbloodclotting:thrombocytopeniaseverehepaticdiseasesleukemiaEtiology/prediction/prevention/management10disseminatedintravascularcoagulopathy(DIC)ifbleedingpersistsinspiteofallothertreatmentdescri