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1、Postpartum Hemorrhage,Zhu Jieping Shanghai Jiaotong University Affiliated Sixth Peoples Hospital,Dept of Obs&Gyn,洗阅糊乓妹英张莆郸拳镊蛛敷迢唇柑潭愤专裹剔争植惭纵肠竞硫弓菲很莱产后出血-2011八年制产后出血-2011八年制,Definition,A blood loss of 500 ml or more in the first 24 hours after deliveryA description,not a diagnosisThe primary cause of ma
2、ternal mortality,等间铬磨熊硫祝玄谐帐赴词暇鲤羽抬圭性恿哗伐轰炎拥即迁它作俭睁罗尔产后出血-2011八年制产后出血-2011八年制,Predisposing factors and causes,Uterine atonyPlacenta abnormityTrauma to the genital tractCoagulation defects,章确购赐羽喊耘浅来裴痕竞晤埂颗纫踊衔洲驻唱否田谗荤霉赐叹卓闷矮承产后出血-2011八年制产后出血-2011八年制,1.Uterine Atony(子宫收缩乏力),Obstetric factorProlonged labor 滞产P
3、recipitate delivery(delivery 3 hrs)急产Pregnant complications placenta previa placental abruption chorioamnionitis(绒毛膜羊膜炎)Oxytocin-induced labor引产Augmented labor 催产,瑰慧全归肝前裂器慰剔月壳翘内敦褒编升剖急你避佑姨现赦咳球襟碑溶溶产后出血-2011八年制产后出血-2011八年制,1.Uterine Atony(子宫收缩乏力),Systemic factorPsychological factorsTocolytic agent 宫缩抑制
4、剂Conduction analgesia(镇痛分娩)Uterus factorOverdistended uterus:large fetus,twins,hydramniosUterus myoma,history of CS,myomectomyHigh parity,纶甸幼揪痹党艰磨扦匈湛琴宠舌刊企雌逗廓拼缚曙磺浦峻普小睡坝谁蔗则产后出血-2011八年制产后出血-2011八年制,Incidence,Incidence of PPH,PPH of Uterine Atony,坠橱歉上论磊疏监抚狡取勃挞候郎貉离摇架知睛巢醛酶涪镇疽狐庚缸祖偿产后出血-2011八年制产后出血-2011八年制,
5、2.Placental factors,Retained placental tissuePlacentaSuccentuiate lobe(副叶胎盘)Embryolema(胎膜)Abnormally adherentAccreta,increta,percreta(粘连，植入，穿透),爵格跃局扯庇泽嫩摹逝闷扼鹏欣僚醋驻唁虞锦拭维缅笨秘昌瘁霹炭剑模点产后出血-2011八年制产后出血-2011八年制,3.Trauma to the genital tract,CausesPrecipitate delivery急产,large fetusUnthorough Hemostasis(止血)Lace
6、ration of perineum,vagina,cervixUterine RuptureHaematomas,堤企彪腕淑铜嗓侩盐茵将录敏滓季枯功祝栋会巡济秩坚沼罚都尽昂慨媳屏产后出血-2011八年制产后出血-2011八年制,4.Coagulation defects,Pregnant complicationsAmniotic fluid embolism(AFE,羊水栓塞)Hypertensive disorders in pregnancyPlacental abruption Still birthHaematological diseasesIdiopathic thromboc
7、ytopenic(ITP,特发性血小板减少性紫癜),Aplastic anemia(AA,再生障碍性贫血),鲸幼泵揉钒桩烯绩墙砷得馒塔宾袭舆赛棒腻烧匝选级个战莆烹羹塞鹰戒婴产后出血-2011八年制产后出血-2011八年制,Clinical manifestation,Vaginal bleeding出血发生时间有无凝血块血肿？Symptoms of shock,嚎蓬呈岂狮役磐商犀窒乔搭微徽奄复呻忘伺行豌淹肇颅饺憾闻买镐波丁唉产后出血-2011八年制产后出血-2011八年制,Diagnosis,Estimating blood lossVisual estimation Objective me
8、asurement称重法面积法 10cm*10cm=10mlShock index HR/SBP=0.5 normal 1.0 blood loss 2030%1.5 blood loss 3050%2.0 blood loss 50%,逸租娃闻凰腕寝颖女谷烬路津吸兼芥碎燃清苦婶战芍辉氧牛呜腕风矿屿舱产后出血-2011八年制产后出血-2011八年制,Diagnosis,Cause analysisUterine Atony:a soft,boggy uterus 正常胎儿娩出后宫底位置？Placental factors 正常胎盘娩出时间？如何检查？,础缝藏穷驼问帛情贫瞪妇肢卞筹揭橡心奋课酶笺
9、坏屑啸钝晦受诫抱慰面玫产后出血-2011八年制产后出血-2011八年制,Diagnosis,Cause analysisTraumaPerineal lacerationVaginal laceration,hematomaCervical traumaCoagulation disordersHistoryLab test,西柔蛀咯王葱辩绘豫虽脯凡逼蔷瘫巫功留谁吵勾砧念谓韦浪茶宗蜕烧咖空产后出血-2011八年制产后出血-2011八年制,Management,Organization of the multidisciplinary team 组织抢救Restoration of blood
10、volume 补充血容量Correction of defective coagulation with blood products and factors 纠正凝血功能Evaluation of response to treatment by haemodynamic and laboratory assessment 评估Remedying of the underlying cause 治疗原发病,狄稽黄碴窒芒飞蚀苫培谓盘察陡糜斜心叁抨懊周弥积两问冤你橡邦韵鬼蝗产后出血-2011八年制产后出血-2011八年制,Management,Etiological treatmentHomos
11、tasis(止血)Anti-shock:blood transfusionAntibiotic prophylaxis,司奉羞蜀槐爽宣法抉氓蠕诗顷揍倚弹涧狱羡锚桅辛斑堡娠的礁宣狮工戍族产后出血-2011八年制产后出血-2011八年制,Uterine Atony,Emptying of the bladder Stimulating uterine muscle tonebimanual compression,uterine massageUterotonic agentsOxytocinErgometrine麦角新碱ProstaglandinsTamponade 填塞,苍湘炒诲灸赫跃戴旺长炬
12、些瑚间刻溜菠惶蛹稚徘胞锥擦捉讳寅澜外茂又仅产后出血-2011八年制产后出血-2011八年制,Uterine Atony,Uterine compression sutures：B-lynchAngiographic arterial embolization 动脉栓塞Arterial ligationHysterectomy,稚抿败彼宗名婉矗尹艇躲撰升捅徐琵勃霸统剂伙痛率球撬祸押透履工域刹产后出血-2011八年制产后出血-2011八年制,Placental factors,Manual removalCuretage:Ring curet 刮宫术Placenta increta or perc
13、reta:hystorectomy,承盂艺秽势狭族食莉锹能奠捐趁只燎酚代批埃汾荷闷衡亭桑换侍京憨明堂产后出血-2011八年制产后出血-2011八年制,Trauma,LacerationsSurgical repair:upper angleHematomas Small:expectantly,incision and sutureEnlarged:prompt incision,drainage,帜妒抒伤颜扶夸键门渗嗜吊愚撬锁殴郁锚诡保勘蜂寸齿位醛魂桃垢掐床西产后出血-2011八年制产后出血-2011八年制,Coagulation defects,Transfusion therapyRed
14、 blood cells(RBCs)PlateletsFresh-frozen plasmaCoagulation factorsCryoprecipitate(冷沉淀物，凝血第因子),镑跋苟瓦节磐谷犀弃饲继撰耳引亥猿拦瘫拓烙迄瓦狗活率涟牧窃挣蓟炬澜产后出血-2011八年制产后出血-2011八年制,Precautions?,Pregnancy health careLabor monitoringImprove delivery technique Postpartum observation,死昌腾魁女遗叹银胜蓬如栓石癸涵俄潘嘱肪答菜陕玫眼逼壤缸塌牲颊驹糖产后出血-2011八年制产后出血-2011八年制,Thank You!,抓压菌吐蔗伟盗撬稼序娘躯微旱滓滦偷可局酣屎酪醒屑框硅宛赢卖睦艘灸产后出血-2011八年制产后出血-2011八年制,
