产后出血2010(北医三院八年制临床医学课件)_PPT幻灯片“Obstetrics is Bloody Business”* Postpartum Hemorrhage: *Cunningham, et. al: Williams Obstetrics, 21st ed., 2001 PPH is the leading cause of death related to pregnancy worldwide… 1 Major causes of death for pregnancy women (maternal mortality) Postpartum hemorrhage(28%) heart diseases pregnancy-induced hypertension (or Amniotic fluid embolism ) infection 2 Definition of PPH The early PPH is defined as a blood loss exceeding 500ml after delivery of the infant< 24 h The late PPH: occurs after 24 hour of delivery to 6 weeks 3 Major causes Uterine atony (90%) Lacerations of the genital tract(6%) Retained placenta(3%-4%) Coagulation defects (blood dyscrasia) (4T: tone, tissue, trauma, thrombin) Etiology/prediction/prevention/management 4 1. Uterine atony Local factors: Overdistention of the uterine Condition that interfere with contraction (leiomyoma) Complications (PIH, anemia, placenta previa) Systemic factors: Nervous Drugs Abnormal labor History of previous PPH Preeclampsia, abnormal placentation Etiology/prediction/prevention/management 5 Pathology Contraction constricting the spiral arteries Preventing the excessive bleeding from the placenta implantation site Uterine atony give rise to PPH when no contraction occur Etiology/prediction/prevention/management 6 plain Have heart palpitations Feel faint Lightheaded Breathless… Etiology/prediction/prevention/management 7 3. Retained placenta Separation and explosion of placenta is caused by strong uterine contraction Placenta tissue remaining in the uterus prevent adequate contraction and predispose to excessive bleeding Etiology/prediction/prevention/management 9 4. Coagulation defects Acquired abnormality in blood clotting: abruption placenta, amniotic fluid embolism severe preeclampsia Congenital abnormality in blood clotting: thrombocytopenia severe hepatic diseases leukemia Etiology/prediction/prevention/management 10
