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1、ObstetricalHemorrhage產(chǎn)科出血概述◆Obstetricsis“bloodybusiness”◆定義(Definitionsofobstetricalhemorrhage):目前尚缺乏明確及統(tǒng)一的界定?Hematocritdropof10volumepercent?Needfortransfusion概述◆美國CDC資料顯示:在非流產(chǎn)相關(guān)(nonabortion-relatedmaternaldeaths)的孕婦死亡中,出血約占30%◆產(chǎn)科出血率也與社會,種族,經(jīng)濟(jì)等因素有關(guān)◆Hemorrhagema
2、ybeantepartumorpostpartum.Hemorrhageisadescriptionofanevent,andnotadiagnosis.◆Becauseofinexactdefinitionsused,theincidenceofobstetricalHemorrhagecannotbedeterminedpreciselyWilliamsObstetrics(21stedition)概述導(dǎo)致產(chǎn)科出血的主要病變分類◆產(chǎn)前出血(antepartumhemorrhage)◆產(chǎn)后出血(postpartumh
3、emorrhage)◆消耗性血凝異常(consumptivecoagulopathy)概述導(dǎo)致產(chǎn)科出血的主要病變----產(chǎn)前出血?胎盤早剝(placentalabruption)?前置胎盤(placentaprevia)概述導(dǎo)致產(chǎn)科出血的主要病變----產(chǎn)后出血?子宮收縮乏力(uterineatony)?胎盤殘留(retainedplacentalfragments)?其他胎盤因素?生殖道裂傷(genitaltractlacerations)?產(chǎn)后血腫(puerperalhematomas)?子宮破裂(ruptureo
4、ftheuterus)概述導(dǎo)致產(chǎn)科出血的主要病變----血凝異常?胎盤早剝?羊水栓塞(Amnionicfluidembolism)?敗血癥(Septicemia)?流產(chǎn)(Abortion)?FetaldeathanddelayeddeliveryTable1:Causesof764pregnancy-relateddeathsduetohemorrhageCauseofhemorrhageNumber(%)Abruptioplacentae141(19)Laceration/uterinerupture125(16)U
5、terineatony115(15)Coagulopathies108(14)Placentafactors76(10)Placentaprevia50(7)Uterinebleeding47(6)Formchichakilandcolleagues.USA,CDC,1999產(chǎn)科出血的高危因素◆胎盤形成異常(Abnormalplacentation)◆分娩時損傷(Traumaduringlaboranddelivery)◆孕婦血容量少(Smallmatermalbloodvolume)◆子宮收縮乏力(Uterineat
6、ony)◆血凝異常(Coagulationdefects)◆其他因素(Otherfactors):肥胖,既往有產(chǎn)后出血史種族因素產(chǎn)科出血的高危因素胎盤形成異常(Abnormalplacentation)◆Placentaprevia◆Placentalabruption◆Placentalaccreta/increta/percreta◆Etopicpregnancy◆Hydatidiformmole產(chǎn)科出血的高危因素分娩時損傷(Traumaduringlaboranddelivery)◆會陰切開術(shù)(Episiotom
7、y)◆Complicatedvaginaldelivery◆Low-ormid-forcepsdelivery◆Cesareandeliveryorhysterectomy◆HighrisksofUterinerupture:PreviouslyscarreduterusHyperstimulationObstructedlaborIntrauterinemanipulationMidforcepsrotation產(chǎn)科出血的高危因素孕婦血容量少(Smallmatermalbloodvolume)◆Smallwomen◆
8、Pregnancyhypervolemianotyetmaximal◆PregnancyhypervolemiaconstrictedSeverepreeclampsiaEclampsia產(chǎn)科出血的高危因素子宮收縮乏力(Uterineatony)◆Overdiatenteduterus:largefetusmutiplefetus
