妇产科学课件：胎盘早剥（英文版)

1、单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Placental abruption,Definition,Occurs after 20,th,weeks,premature separation of the normally situated placenta before delivery of fetus,Incidence:,in abroad:1%-2%,in our country:0.46%-2.1%.,The fetal mortality is depending on the degree of separation.,Placental abruption is a severe complication of late pregnancy.It is also a significant contributor to maternal mortality.,peels away from the inner wall of the uterus before delivery deprive of oxygen an

2、d nutrients of the fetus heavy bleeding in the mother.mother and baby in jeopardy.,Etiology,(1)vascular lesion,：,PIH,especial severe pre-eclampsia,chronic hypertension,chronic renal disease-vascular sclerosis spasm,-Local vascular injury-vascular rupture into decidual basalis -bleeding,hematoma formation-shears off adjacent denuded vessels,separation of the placenta from the uterine wall.,producing further bleeding and enlarging the separated area,Etiology,uterine venous congestion-sudden rise i

3、n uterine venous pressure to intervillous space-congestion or rupture of venous bed-hematoma formation-separation of placenta and uterine wall,Etiology,(2)Sudden uterine decompression,：,premature rupture of membrane(especially the preterm PROM),the first fetus is delivered rapidly in twin.,amniotic fluid flowed rapidly in polyhydramnios,the uterine cavitys pressure decreased suddenly,uterus contracts,which cause the separation of the placenta and uterus.,Etiology,(3)Mechanical factors:,trauma or

4、 injury to the abdomen,short umbilical cord(absolute or relative),In amniocentesis,injure the vessel in the attachment of placenta-hematoma behind the placenta formation-separation of the placenta and uterine wall,Predisposing factors,Previous placental abruption.,Advanced maternal age,Multipara,Smoking,Predisposing factors,Abnormal metabolism,Predisposing thrombosis.,Uterus myoma.,drug abuse.,Pathological changes,bleeding to decidual basalis,hematoma of,retroplacenta,Separation of the placenta

5、and uterine wall,Revealed or external bleeding,the complications are fewer and less severe.Small amount bleeding and quickly cease.No obvious symptoms.,concealed or internal placental abruption,The hemorrhage is confined within the uterine cavity,detachment of the placenta may be complete,and the complications are often severe.,Mixed bleeding,concealed or internal placental abruption,The placenta marginal incomplete,Utero-placental apoplexy(Couvelaire uterus),the placental margins remain adheren

6、t,hemorrhage that infiltrates the uterine wall.,Uterine tetany follows,extensive intra myometrial bleeding-purplish and copper-colored,ecchymosis,loses its contractile power because of disruption of the muscle bundles.,DIC(disseminated intravascular coagulation),The mother may then develop a widespread petechiae,active bleeding,，,shock,and failure of the normal clotting mechanism.,Acute renal failure,：,acute renal cortical and tubular necrosis.,thromboplastinfrom the villi and decidua of the str

7、ipping side,Mothers circulation,Activate blood coagulation system,Micro-thrombosis in capillary of the lung,kidney.,Ischemia and dysfunction of the organs,agglutinant,Mothers circulation,Activate fibrinolytic system,FDP,Hyperfibrinolysis,DIC,Enter into,Enter into,form,secondary,Consume blood coagulation factor,Clinical findings and diagnosis,patients report of her symptoms,physical examination performed.,tested to evaluate the possibility of life-threatening problems with the mothers clotting sy

8、stem.,Symptoms and signs,begin anytime after 20 weeks of pregnancy.,Classic signs and symptoms of placental abruption depending on the site and extent of bleeding,there are 3 grades.,clinical findings correspond to the degree of separation.,About 30%of separations are small,produce few or no symptoms,and usually are not noted until the placenta is inspected.,Symptoms,degree:,External bleeding,often seen during labor,Separated area is small,No pain in the abdomen or back,no anemia,Uterus,：,soft,F

9、etus,：,normal,Symptoms,degree:,Separated area is about 1/3 of the placenta.,No or small vaginal bleeding,anemia of the patient is not match to bleeding.,Sudden occurred abdominal pain,sore waist or low back pain.,Uterus,：,enlarged,uterine height increased,tenderness of the separated place,intermittence during uterine contraction.,Fetus,：,survival,Symptoms,degree:,Separated area is,1/2 of the placenta.,Nausea,vomitting,pale,blood pressure decrease,pulsation extenuate etc shock symptoms,which is c

10、orrespond to the maternal blood loss.,Uterus,：,hard like a board,no relaxation during uterine contraction intermittence.,Fetal position is not so clear,Fetus,：,fetal heart rate vanish,fetal death.,Concealed:no visible vaginal bleeding,bleeding is trapped behind the placenta,bleeding into the muscle of the uterus.,abnormal contractions of the uterus,particularly extremely hard,prolonged contractions.,mother,symptoms of organ failure as her organs are deprived of oxygen.,a drop in blood pressure,L

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