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1、教学内容胎儿窘迫、子宫破裂、产后出血——约2学时脐带异常、羊水量异常、早产、 胎膜早破、过期妊娠、多胎妊娠——约1学时＋自学王正平浙江大学医学院附属妇产科医院产科Tel：87061501－2061PostPartumHemorrhage UterineRupture,FetalDistressWomenHospital,SchoolofMedical,ZheJiangUniversityWangZhengPingPostpartumhemorrhagePostpartumhemorrhagePastpartumhemorrhage
2、denotesexcessivebleeding(≥500mlinvaginaldelivery)duringthefirst24hoursafterdeliveryCommoncauseofdeathanddiseasesinpregnantwomengloballyLeadingcauseofdeathinpregnantwomeninChinaIncidence2%-3%oftotalnumberofdeliveriesEtiologyUterineatony:70%Obstetriclacerations:20%Retai
3、nedplacentaltissue:10%Coagulation:1%UterineatonyGeneralfactors:extremenervousness,sedative,anesthesia,tocolytics,weakObstetricfactors:prolongedlabour,fatigue,placentaprevia,placentaabruptio,severeanemiaUterinefactors:uterinemuscularfiberunderdevelopment,suchasuterined
4、eformityormyoma;uterineoverstretched,suchasmacrosomia,multiplepregnancy,polyhydramniosPlacentalfactorsIncompleteplacentalseparationRetainedplacentaPlacentalincarceration（嵌顿）PlacentaladhesionPlacentalimplantation(accreta,increta,percreta)Residualplacentaandamnioticmemb
5、raneBirthcanalinjuryLacerationduringlabourareusuallyassociatedwith:PoorvulvalelasticityStronglabourforce,emergencydelivery,macrosomiaInadequateskillsatassistedvaginaldeliveryInadequatecessationofbleedingduringepisiotomyrepair,missingouttearsatcervixorfornicesCoagulati
6、ondisorderComplicationsassociatedwithobstetric:amnioticfluidembolism,pregnancyinducedhypertensivediseases,placentaabruptioandintrauterinedemisePregnancyliverdisease:acutefattyliver,severehepatitisHematologydiseases:primarythrombocytopenicpurpura,aplasticanemiaetcClini
7、calpresentationVaginalbleeding:Ifbleedingoccursimmediatelyafterdeliveryofbaby,considerbirthcanalinjuryIfbleedingoccursminutesafterdeliveryofbaby,considerplacentafactorsIfbleedingoccursminutesafterdeliveryofplacenta,mainreasonsareuterineatonyorretainedproductsofconcept
8、ionPersistentbleedingandblooddonotcoagulate,considercoagulationdisordercausingPPHClinicalpresentationVaginalhematomaShock:di
