产科急症的辨识和处置

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
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) –
▪ 合并症:胎盘早剥 ,胎位异常,产后出血 ▪ 处理： 卧床、抗-D和防栓塞 Bed rest,
Anti-D and Thrombosis prophylaxis
分娩方式DELIVERY MODUS
剖宫产Practically all women do need cesarean section.
高危因素:
I. 先前有胎盘早剥Previous abruption (x 10) II. 宫肌瘤Myoms III. 子宫纵膈Uterusseptum IV. 母亲疾病：高血压、栓塞性疾病、Maternal
diseases: Hypertension, Thrombophilia , Hyperhomocysteinemia V. 胎盘异常：环状Abnormal Placentation :for example: Plac. Circumvallata VI. 滥用尼古丁和可卡因Nicotine & Cocaine Abuse VII. 腹部外伤Blunt Abdominal Trauma
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)
先前宫腔操作史-吸烟
完全性
完全性（圆盘型）
部分性
Fra Baidu bibliotek
边缘性MARGINALIS
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
氧或缺血以及感染，绒毛从蜕膜板分离。
出血类型
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 sonography
Grade 1 :有外、内出血迹象，母循环系统 无变化，无胎儿窘迫。scant external & internal bleeding.No maternal circulatory changes;No fetal distress.
HELLP综合症 胎盘早剥、肝 破裂、脑出血
产科急症内容
出血 BLEEDING 休克 SHOCK 脐带脱垂 UMBLICAL CORD PROLAPS 肩难产 SHOULDER DYSTOCIA 羊水栓塞 AMNIOTIC FLUID EMBOLISM 子宫内翻 UTERUS INVERSION 子宫破裂 UTERUS RUPTURE
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
产科急症的辨识和处置
广州医学院第三附属医院 广州市重症孕产妇救治中心
李映桃 email：yingtao9777@yahoo.cn
广州医学院第三附属医院 广州市重症孕产妇救治中心 李映桃 email：yingtao9777@yahoo.cn
Intensive care unit
妊娠并脑瘤 重度子痫前期
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３０ ％伴有DIC和胎儿濒死。severe external & internal bleeding.The uterus very painfull; fetal demise;maternal shock in 30% of cases associated with coagulation disorders.
疤痕子宫、前置胎盘、胎盘植入
前置胎盘、 胎盘植入
前置胎盘， 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
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%)
处理