胎盤早剝英文課件

1、Placenta abruptio,,,Alternative names    Return to top Premature separation of placenta; Accidental hemorrhage; Ablatio placentae; Abruptio placentae; Placental abruption,,Definition    (a

2、fter the 20th week or during delivery)The separation of the placenta(in normal site) from the site of uterine implantation before delivery of the fetus.,Causes,Direct causes (1 to 5%). mechanical factors such as ab

3、dominal trauma (for example, from an auto accident or fall) sudden loss in uterine volume ( rapid loss of amniotic fluid or the delivery of a first twin0 abnormally short umbilical cord (usually only a problem at the t

4、ime of delivery).,Predisposing factors,a past medical history of placenta abruptio (after 1 prior episode there is a 10 to 17% recurrence, after 2 prior episodes the incidence of recurrence exceeds 20%)hypertension or h

5、igh blood pressure during pregnancy is associated with 2.5 to 17.9% incidence (however, approximately 50% of placenta abruptio cases severe enough to cause fetal death are associated with hypertension),,increased materna

6、l ageincreased number of prior deliveries increased uterine distention (as may occur with multiple pregnancies or abnormally large volume of amniotic fluid)diabetes mellitus in the pregnant woman cigarette smoking; c

7、ocaine abuse; and drinking alcohol during pregnancy (more than 14 drinks per week).,Incidence,The incidence of placenta abruptio, including any amount of placental separation prior to delivery, is about 1 out of 150 deli

8、veries. However, the severe form (resulting in fetal death) occurs only in about 1 out of 500 to 750 deliveries,Pathologic changes,Revealed abruptionConcealed abruptionMixed typeBloody emniotic fliudUteroplacental ap

9、oplexyDIC,classification,Mild typeSevere type1/3,Clinical findings,Symptoms    Vaginal bleeding Abdominal pain Back pain Signs and tests    Physical examination reveals uterine tend

10、erness and/or increased uterine tone. Hemorrhage or heavy bleeding in pregnancy may be visible or concealed.,Tests,A CBC, may note decreased hematocrit or hemoglobin and platelets Prothrombin time test Partial thrombop

11、lastin time test Fibrinogen level test Abdominal ultrasound (may be done),,Diagnosis Differential diagnosisPlacenta previaThreatened rupture of uterus,Complications,Excessive loss of blood that may lead to shock and

12、 possible fetal and/or maternal death is the most evident complication. If the site of placental attachment starts to hemorrhage after the delivery and loss of blood cannot be controlled by other means, a hysterectomy (r

13、emoval of the uterus) may become necessary.,Chinese textbook,ComplicationsDICHaemorrhagic shockAmniotic fluid embolismAcute renal failtureIntrauterus fetal demise,Treatment,Correct shockMonitoring the state of fetu

14、sTermination of the pregnancyCorrect DICPrevention of renal failture,Expectations (prognosis),Maternal mortality is uncommon: range from 0.5 to 5%. Early diagnosis of the condition and adequate intervention should dec

15、rease the maternal death rate to 0.5 to 1%. Fetal death rates range from 20-35 %. Upon hospital admission, no fetal heart tone is detectable in about 15% of cases. Fetal distress appears early in the condition in approx

16、imately 50% of cases. The infants who live have a 40 to 50% incidence of illness.,,Concealed vaginal bleeding in pregnancy, excessive loss of blood resulting in shock, absence of labor, a closed cervix, and delayed diagn