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胎盘早剥

placental abruption. 胎盘早剥. Definition. After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption. Etiology. Vascular injury

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胎盘早剥

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  1. placental abruption 胎盘早剥

  2. Definition After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption

  3. Etiology • Vascular injury PIH syndrome chronic renal disease • mechanical factors twins polyhydramnios short umbilical cord • suddenly rising of the uterus venous pressure

  4. Pathophysiology • The hemorrhage in the decidua • forming hematoma behind placenta • separate from wall of the uterus

  5. Classification • A revealed abruption • B concealed abruption • C mixed hemorrhage

  6. 显性出血

  7. 隐性出血

  8. 混和性出血

  9. 病 例 王铭，女，27岁，以“停经九个月，胎动五个月，突发性下腹痛伴阴道流血一小时”为主诉入院。平素月经规律，早孕 反应不明显，孕18周觉胎动，活跃至今，一小时前无明显诱因突发下腹痛，阴道 少量流血，鲜红，无意识模糊等表现。 查体：T37.2℃，P21次/分，BP85/55mmHg，心肺听诊无异常，腹 膨隆，孕足月腹， 纵产式腹肌紧张，子宫易激惹，右下腹有一局限性压痛点，阴道流血少量。

  10. 实验室检查：血常RBC2OO×1012/L，HGB8.7g/L,WBC11.4×109。 辅助检查：B超示BPD9.5cm，FL7.4 cm,胎盘位于后壁，与子宫间见一个3× 5cm 低回声区，未见胎心反射。

  11. Clinical manifestations Mild type during labor revealed abruption ＜1/3 in size vaginal bleeding slight abdominal pain uterus is soft fetal position is clear fetal heart sounds is clear

  12. Clinical manifestations Severe type PIH symptoms concealed or mixed abruption ＞1/3 in size a lot of blood uterus enlarged rapidly increasing pain pallor out of proportion to amount of vaginal bleeding fetal position is not clear fetal heart sound disappear

  13. Assistant examination • B-ultrasound examination • laboratory findings A the degree of anemia B funtion of coagulation

  14. Diagnosis • History • signs • examination • assistant examination

  15. Differential diagnosis • Placenta previa • impending rupture of uterus

  16. Complications • DIC and dysfunction clotting • postpartum hemorrhage • acute renal failure • Sheehan, s syndrome

  17. Prevention • Improving prenatal care • improving treatment for high risk pregnancy

  18. Trestment⑴ • Correct shock • terminating pregnancy A vaginal delivery B cesaerean section • Preventingpostpartum hemorrhage

  19. Treatment⑵ • Treating the dysfunctional clotting A transfusing fresh blood B transfusing fibrinogen（纤维蛋白原） C transfusing fresh plasma D use of heparin（肝素） E anti-fibrinogenolysis agent（抗纤溶剂） • preventing failure of renal function urine volume＜30ml/h 补充血容量 ＜17ml/h 肾衰

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