产后出血(postpartumhemorrhage).ppt

教学内容胎儿窘迫、子宫破裂、产后出血——约2学时脐带异常、羊水量异常、早产、胎膜早破、过期妊娠、多胎妊娠——约1学时+自学王正平浙江大学医学院附属妇产科医院产科Tel:87061501-2061PostPartumHemorrhageUterineRupture,FetalDistressWomenHospital,SchoolofMedical,ZheJiangUniversityWangZhengPingPostpartumhemorrhagePostpartumhemorrhagePastpartumhemorrhagedenotesexcessivebleeding(≥500mlinvaginaldelivery)moncauseofdeathanddiseasesinpregnantwomengloballyLeadingcauseofdeathinpregnantwomeninChinaIncidence2%-3%oftotalnumberofdeliveriesEtiologyUterineatony:70%Obstetriclacerations:20%Retainedplacentaltissue:10%Coagulation:1%UterineatonyGeneralfactors:extremenervousness,sedative,anesthesia,tocolytics,weakObstetricfactors:prolongedlabour,fatigue,placentaprevia,placentaabruptio,severeanemiaUterinefactors:uterinemuscularfiberunderdevelopment,suchasuterinedeformityormyoma;uterineoverstretched,suchasmacrosomia,multiplepregnancy,pleteplacentalseparationRetainedplacentaPlacentalincarceration(嵌顿)PlacentaladhesionPlacentalimplantation(accreta,increta,percreta)Residualplacentaandamnioticmembrane