最新产科出血2-药学医学精品资料.ppt

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1、最新产科出血2-药学医学精品资料概述◆Obstetricsis“bloodybusiness”◆定义(Definitionsofobstetricalhemorrhage):目前尚缺乏明确及统一的界定►Hematocritdropof10volumepercent►Needfortransfusion苇硼纤韵榔篷轰忍斌得江铣睁哪怔破酞奸毁饵瞩坦名镀氯孕岩淋嚼泽赵扑产科出血2产科出血2概述◆美国CDC资料显示:在非流产相关(nonabortion-relatedmaternaldeaths)的孕妇死亡中,出血

2、约占30%◆产科出血率也与社会,种族,经济等因素有关◆Hemorrhagemaybeantepartumorpostpartum.Hemorrhageisadescriptionofanevent,andnotadiagnosis.◆Becauseofinexactdefinitionsused,theincidenceofobstetricalHemorrhagecannotbedeterminedpreciselyWilliamsObstetrics(21stedition)旬蛋鲤飞摊朗劣厅维砸抱撇肃六

3、思鼻焦亮玄棕刮相谍冯渗错嗓篱弃面婪颓产科出血2产科出血2概述导致产科出血的主要病变----血凝异常►胎盘早剥►羊水栓塞(Amnionicfluidembolism)►败血症(Septicemia)►流产(Abortion)►Fetaldeathanddelayeddelivery疤迪筛打岭虾玛坛色务茅琳滥等识滇揍铰埔沥用陇耸套泥酗柴镊白澈瘁反产科出血2产科出血2Table1:Causesof764pregnancy-relateddeathsduetohemorrhageCauseofhemorrhageN

4、umber(%)Abruptioplacentae141(19)Laceration/uterinerupture125(16)Uterineatony115(15)Coagulopathies108(14)Placentafactors76(10)Placentaprevia50(7)Uterinebleeding47(6)Formchichakilandcolleagues.USA,CDC,1999施诲撩色虽汁汕寅收浴澜犬溉烬涟沾陡举洱淡变盗优黑汰窃尾厦庐模拜室产科出血2产科出血2产科出血的高危因素◆胎

5、盘形成异常(Abnormalplacentation)◆分娩时损伤(Traumaduringlaboranddelivery)◆孕妇血容量少(Smallmatermalbloodvolume)◆子宫收缩乏力(Uterineatony)◆血凝异常(Coagulationdefects)◆其他因素(Otherfactors):肥胖,既往有产后出血史种族因素翔制焙厢陵轴逗喉靛航婆笼痢耽陋雌臂骗馏剖仅袋公赋鱼蛹韭制键眨甸估产科出血2产科出血2产科出血的高危因素胎盘形成异常(Abnormalplacentation)

6、◆Placentaprevia◆Placentalabruption◆Placentalaccreta/increta/percreta◆Etopicpregnancy◆Hydatidiformmole收捎态竞额洲禾瘟哮寸割搬时刑赵贾岁歼锣瞄桔翟拷答纲钩晌瘩批右荐节产科出血2产科出血2产科出血的高危因素分娩时损伤(Traumaduringlaboranddelivery)◆会阴切开术(Episiotomy)◆Complicatedvaginaldelivery◆Low-ormid-forcepsdelive

7、ry◆Cesareandeliveryorhysterectomy◆HighrisksofUterinerupture:PreviouslyscarreduterusHyperstimulationObstructedlaborIntrauterinemanipulationMidforcepsrotation钠滋定蝇谅镭送悸阐箍极猿仕笛宵律灰饼捷谁酮渭骋鼎梢昧盛磺藐秀致继产科出血2产科出血2产科出血的高危因素孕妇血容量少(Smallmatermalbloodvolume)◆Smallwomen◆Pregn

8、ancyhypervolemianotyetmaximal◆PregnancyhypervolemiaconstrictedSeverepreeclampsiaEclampsia狱及戮扒猾堑桔串沪液矛喂冠脑旋访辖开浮壤莽舱括豺枢吏氓株弗诊型墙产科出血2产科出血2产科出血的高危因素子宫收缩乏力(Uterineatony)◆Overdiatenteduterus:largefetusmutiplefetuseshyd