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1、Placental AbruptionZongjun Hao Department of Ob&GyTaian public Health School of Shandong Province胎盘早期剥离胎盘早期剥离2023/1/121 孕妇，30岁，G1P0，36周妊娠，2h前腹部受外伤后出现持续性腹痛而入院。检查：孕妇面色苍白，血压60/40 mmHg，胎心率100次/min，子宫底位于剑突下2横 指，子宫压痛，张力高。正确处理方法为：A、给予镇静止痛剂B、纠正休克后继续妊娠 C、纠正休克，同时行剖宫产术 D、应用子宫收缩抑制剂病例病例C2023/1/122难点难点Difficult p
2、ointsPathology of placental abruption.胎盘早剥的胎盘早剥的病理病理 Etiology、Clinical chracateristic and Treatment病因和治疗原则病因和治疗原则重重 点点emphasis学习目标sdudying Aims Grasp the definition、Etiology、Pathology、Clinical chracateristic and priciples of placental abruption.掌握胎盘早剥的定义、掌握胎盘早剥的定义、发病原因、发病原因、病理及其临床特点和治疗原则病理及其临床特点和治疗原
3、则2023/1/123General Considerationperinatal morbidity发病率发病率 0.46%-2.1%(our country)1%(other countries）perinatal mortality死亡率死亡率 20%-35%Definition 定义定义 The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery.妊娠妊娠2020周后或在分娩期发生正常位置的胎盘发生周后或
4、在分娩期发生正常位置的胎盘发生部分或全部从子宫壁剥离。部分或全部从子宫壁剥离。2023/1/124Etiology 病因病因 Risk factors1、Vascular diseases:血管疾病血管疾病 preeclampsia,chronic hypertension,renal disease.先兆子痫、慢性高血压、慢性肾病等先兆子痫、慢性高血压、慢性肾病等2、Mechanical factors:机械性损伤机械性损伤 trauma,intercourse etc.外伤外伤、性生活、性生活、外倒转术纠正胎位等外倒转术纠正胎位等2023/1/125Etiology 病因病因 Risk f
5、actors3、Supine hypotensive syndrome 仰卧位低血压综合征仰卧位低血压综合征4、reducing of uterine presure suddenly 宫腔内压力骤降宫腔内压力骤降 multiple gestaion,hytramnios etc.5、others:其它其它 short umbilical cord etc.脐带过短、绕颈等脐带过短、绕颈等2023/1/126PathologyMain change 主要病理改变主要病理改变 hemorrhage of the decidua basalis 底蜕膜出血底蜕膜出血2023/1/127Pathol
6、ogy change hemorrhage of the decidua basalis 底蜕膜螺旋动脉破裂出血底蜕膜螺旋动脉破裂出血 decidua splits 底蜕膜分离底蜕膜分离 decidural hematoma 底蜕膜血肿底蜕膜血肿 separation,compression,destruction of the placenta adjacent to it 剥离、出血、挤压、剥离剥离、出血、挤压、剥离恶性循环恶性循环2023/1/128PathologyTypes分类分类 revealed abruption 显性剥离显性剥离 concealed abruption 隐性剥
7、离隐性剥离 mixed abruption 混合剥离混合剥离2023/1/129Clinical chracteristics Sudden ，continuous abdominal pain 突然的、持续的腹痛突然的、持续的腹痛Vaginal bleeding 阴道出血阴道出血2023/1/1210Uteroplacental apoplexy 子宫胎盘卒中子宫胎盘卒中Hypovolemic shock 低血容量性休克低血容量性休克Amniotic fluid embolism 羊水栓塞羊水栓塞Acute renal failure 急性肾功能衰竭急性肾功能衰竭Postpartum hem
8、orrhage 产后出血产后出血DIC 弥漫性血管内凝血弥漫性血管内凝血Complication并发症并发症2023/1/1211TreatmentTreatment of hypovolemic shock:抗休克抗休克 intensive transfusion with bloodTermination of pregnancy 尽快终止妊娠尽快终止妊娠 promptly:Cesarean or Vaginal deliveryControl complications：控制并发症控制并发症2023/1/1212 初孕妇，29岁，妊娠35周，以往无高血压病 史，近一周来血压160170/100110mmHg，现因下腹痛3h伴阴道流血入院，如果你是接诊护士，你首先想到是什么疾病？homework2023/1/1213Thank you!Thank you!2023/1/1214Pathology 1revealed abruption 显性出血显性出血2023/1/1215Pathology 2concealed abruption 隐性出血隐性出血2023/1/1216Pathology 3mixed abruption 混合性出血混合性出血2023/1/1217