过期妊娠教学课件

Postterm Pregnancy过过 期期 妊妊 娠娠妊娠达到或超过42周尚未分娩者。Post-termpregnancyisdefinedasapregnancythathasextendedtoorbeyond42weeksofgestation(294days,orestimateddateofdeliveryEDDplus14days).TerminologyPathophysiologyPLACENTALCHANGESPLACENTALCHANGES:hypofunction:hypofunction功能减低功能减低胎盘胎盘AMNIOTICFLUIDCHANGESAMNIOTICFLUIDCHANGES:羊水羊水oligohydramniosoligohydramnios羊水过少羊水过少presenceofmeconiumpresenceofmeconium粪染粪染FETALCHANGESFETALCHANGES:placenatafunction:placenatafunction 胎儿胎儿25%-macrosomia25%-macrosomia巨大儿巨大儿10-20%-postmaturitysyndrome10-20%-postmaturitysyndrome成熟障碍综合征成熟障碍综合征Complications MATERNALMATERNALDystociaDystocia巨大儿巨大儿TraumaticvaginalTraumaticvaginal阴道损伤阴道损伤IncreasedCSrateIncreasedCSrate剖宫产率增加剖宫产率增加FETALFETALFetaldistressFetaldistress胎儿宫内窘迫胎儿宫内窘迫FetaltraumaFetaltrauma胎儿损伤胎儿损伤IncreasedperinatalIncreasedperinatalmortalitymortality围产儿死亡率增高围产儿死亡率增高如何判定孕周如何判定孕周孕早期时，头臀长(CRL)是确定孕周最好的指标当CRL84 mm时，不建议继续用于孕周的确定，而双顶径此时仍可用于孕周的确定孕16-20周测量双顶径估计孕周Management （一）Placentalfunctionmonitor:胎盘功能监测Fetalmovementrecording胎动Electronicfetalmonitoring电子胎心监护Biophysicalprofile生物物理评分Ultrasoundscan超声UrineE3、E/C尿检Management （二）Cervicalripening（促宫颈成熟）Bishop小于4分普拉睾酮200mg+5%葡萄糖20ml,iv,qd,共用3日普贝生（地诺前列酮）栓剂10mg阴道用药LaborinductionBishop7分2.5U缩宫素+5%葡萄糖500ml，8滴/分（20滴1ml）cesareandelivery剖宫产胎盘功能不良估计体重4000g合并糖尿病胎位异常存在合并症及并发症引产失败或产程进展慢，疑有头盆不称产时胎儿窘迫核实孕周和判断胎盘功能是处理的关键。对妊娠41周以后的孕妇可常规引产。根据胎儿情况选择分娩方式。引产前应做宫颈Bishop评分，若4分须先促宫颈成熟。小结