产科急症的辨识和处置之产前出血课件.ppt
产前出血,前置胎盘胎盘早剥帆状胎盘血管前置宫颈息肉宫颈糜烂外伤疤痕子宫破裂肿瘤,1,产科急症的辨识和处置之产前出血,产前出血前置胎盘1产科急症的辨识和处置之产前出血,前置胎盘,定义：胎盘部分或全部覆盖宫内口。 完全性 totalis 部分性 partialis 边缘性marginalis发生率：0.5% -1% of all births.高危因素：剖宫产史(x 6)- 多产(x 2.6) 先前宫腔操作史-吸烟,2,产科急症的辨识和处置之产前出血,前置胎盘定义：胎盘部分或全部覆盖宫内口。2产科急症的辨识,完全性,3,产科急症的辨识和处置之产前出血,完全性3产科急症的辨识和处置之产前出血,完全性（圆盘型）,4,产科急症的辨识和处置之产前出血,完全性（圆盘型）4产科急症的辨识和处置之产前出血,部分性,5,产科急症的辨识和处置之产前出血,部分性5产科急症的辨识和处置之产前出血,9.1.1 采购绩效评估的目的,确保采购目标之实现 提供改进绩效之依据 作为个人或部门奖惩之参考 协助人员甑选与训练 促进部门关系 提高人员的士气,6,产科急症的辨识和处置之产前出血,9.1.1 采购绩效评估的目的确保采购目标之实现 6产科急,9.1.2 采购绩效评估小组的组成,采购部门主管 财务部门 销售部门 生产主管部门或工程部门 供应商 专家顾问,7,产科急症的辨识和处置之产前出血,9.1.2 采购绩效评估小组的组成采购部门主管 7产科急,9.1.3 采购绩效评估标准,历史绩效标准预算或标准绩效行业平均绩效标准目标绩效标准 小思考:何种情况下选择何种绩效标准？,8,产科急症的辨识和处置之产前出血,9.1.3 采购绩效评估标准历史绩效标准8产科急症的辨识和,边缘性MARGINALIS,9,产科急症的辨识和处置之产前出血,边缘性MARGINALIS9产科急症的辨识和处置之产前出血,前置胎盘,临床特点:母源性无痛性阴道流血 painless bleeding of maternal origin诊断:1. 超声Sonography 2.阴窥If cervical os dilated cautious inspection合并症:胎盘早剥 ,胎位异常,产后出血处理： 卧床、防栓塞 等Bed rest, Thrombosis prophylaxis,10,产科急症的辨识和处置之产前出血,前置胎盘临床特点:母源性无痛性阴道流血 painless,分娩方式DELIVERY MODUS,剖宫产Practically all women do need cesarean section.注意点: 1.胎儿早产又无分娩指征（观察）The fetus is preterm and there is no indication for delivery.(observe) 2.胎儿成熟母出血不止（c.s)The fetus is mature and the bleeding does not stop.(cesarean S) 3.孕妇临产The patient is in labor (cesarean S) 4.出血严重胎儿不成熟（c.s)The bleeding severe,and the fetus immature (cesarean S),11,产科急症的辨识和处置之产前出血,分娩方式DELIVERY MODUS剖宫产Practical,疤痕子宫、前置胎盘、胎盘植入,12,产科急症的辨识和处置之产前出血,疤痕子宫、前置胎盘、胎盘植入12产科急症的辨识和处置之产前出,前置胎盘、胎盘植入,13,产科急症的辨识和处置之产前出血,前置胎盘、胎盘植入13产科急症的辨识和处置之产前出血,前置胎盘 产前出血,14,产科急症的辨识和处置之产前出血,前置胎盘14产科急症的辨识和处置之产前出血,胎盘早剥PLACENTAL ABRUPTION,孕产妇死亡的主因One of the leading causes of the perinatal mortality发生率: 0.5% - 1% of all deliveries病生Pathophysiology: 因腹部外伤、母缺氧或缺血以及感染，绒毛从蜕膜板分离。,15,产科急症的辨识和处置之产前出血,胎盘早剥PLACENTAL ABRUPTION孕产妇死亡,出血类型,16,产科急症的辨识和处置之产前出血,出血类型16产科急症的辨识和处置之产前出血,临床分级CLINICAL STAGING,Grade 0: 无症状，仅从超声和产后检查诊断。asymptomatic;diagnosis often postnatal or by sonographyGrade 1 :有外、内出血迹象，母循环系统无变化，无胎儿窘迫。scant external No fetal distress.,17,产科急症的辨识和处置之产前出血,临床分级CLINICAL STAGINGGrade 0:,Grade 2 :严重出血和胎儿窘迫heavy bleeding (external internal) Fetal distress (CTG )Grade 3 :严重出血、子宫剧痛和休克伴有DIC和胎儿濒死。severe external maternal shock in 30% of cases associated with coagulation disorders.,18,产科急症的辨识和处置之产前出血,Grade 2 :严重出血和胎儿窘迫heavy bleedi,高危因素:,先前有胎盘早剥Previous abruption (x 10)宫肌瘤Myoms子宫纵膈Uterusseptum母亲疾病：高血压、栓塞性疾病、Maternal diseases: Hypertension, Thrombophilia , Hyperhomocysteinemia 胎盘异常：环状Abnormal Placentation :for example: Plac. Circumvallata 滥用尼古丁和可卡因Nicotine & Cocaine Abuse腹部外伤Blunt Abdominal Trauma,19,产科急症的辨识和处置之产前出血,高危因素:先前有胎盘早剥Previous abruption,诊断DIAGNOSIS,疼痛性阴道出血Painfull vaginal bleeding板状腹Tetanic contractions of uterus胎心监护异常Pathological CTG超声图像Sonography: (敏感性 Sensitivity : 50%),20,产科急症的辨识和处置之产前出血,诊断DIAGNOSIS疼痛性阴道出血Painfull va,21,产科急症的辨识和处置之产前出血,21产科急症的辨识和处置之产前出血,处理,无症状No symptoms(no bleeding ) :观察母胎情况observe the mother and the fetus .严重出血胎儿存活：C.S。Severe bleeding +the fetus is alive: Cesarean section.出血胎儿死亡：人工破膜成份输血阴道分娩引产，但若出血太严重则剖宫产。Clinical symptoms (bleeding)+the fetus is dead : Amniotomy +packed red cells+coagulation factors +labor induction (vaginal birth),but if the bleeding too severe then cesarean section,22,产科急症的辨识和处置之产前出血,处理无症状No symptoms(no bleeding ),子宫内部出血BLEEDING INTRAPARTAL,见红BLOODY SHOW血管前置VASA PRAEVIA帆状胎盘前置INSERTIO VELAMENTOSA胎盘早剥ABRUPTIO PLACENTAE子宫破裂UTERINE RUPTURE,23,产科急症的辨识和处置之产前出血,子宫内部出血BLEEDING INTRAPARTAL见红B,血管前置若人工破膜后出血要想起该病！,24,产科急症的辨识和处置之产前出血,血管前置若人工破膜后出血要想起该病！24产科急症的辨识和,帆状胎盘血管前置INSERTIO VELAMENTOSA,25,产科急症的辨识和处置之产前出血,帆状胎盘血管前置INSERTIO VELAMENTOSA,帆状胎盘INSERTIO VELAMENTOSA,26,产科急症的辨识和处置之产前出血,帆状胎盘INSERTIO VELAMENTOSA26产科急,产前出血入院7次，多次超声（）。孕39周，临床出血120mlC.S.,27,产科急症的辨识和处置之产前出血,产前出血入院7次，多次超声（）。孕39周，临床出血120m,
