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ID:57288984
大小:1.60 MB
页数:44页
时间:2020-08-10
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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:140-150bpmCase1WhatarethemostcommoncausesofAntepartumHemorrhag
2、e?COMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselruptureCervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorderUnknown(byexclusionoftheabove)PlacentalPrev
3、iaUnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectivesDefinedastheinf
4、erioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal:0.24%~1.57%;International:0.5%~0.9%。PlacentalPrevia“theplacentaoverlyingtheinternalosofthecervix”ClassificationClassificationCo
5、mplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentapreviaWhataretheriskfactorsforplacentalPrevia?QuestionETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesor
6、InducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGYManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentationManifestationTheclassificationofpreviaplacentasometim
7、esdeterminestheoccurrenceperiodandthevolumeoflosingblood.TotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentapreviaBetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacent
8、apreviaBetweentotalandmarginalMarginalplacentapreviaLate(37-40WKSorinlabor)LessbleedingsymptomSeverebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.Malpresentationmaybeexists,andfloatingpresentationcou
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