扬州大学：《妇产科学》课程教学课件（PPT讲稿）21 胎盘早剥 Placental Abruption

Placental AbruptionLiu WeiDepartmentof Ob &GyRenJihospital

Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital

General ConsiderationDefinitionThe separation of the placenta from its site ofimplantation after 20 weeks of gestation orduring the course of delivery.Frequency0.51%-2.33% (our country)1% (other countries)Incidence offetal death200%0-350%0

General Consideration • Definition The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. • Frequency 0.51%-2.33% (our country) 1% (other countries) • Incidence of fetal death 200‰-350‰

EtiologyUncertain (primary cause)RiskfactorsIncreased age and parityVascular diseases: preeclampsia, chronichypertension, renal disease.3Mechanical factors: trauma, intercoursepolyhydramnios,Supinehypotensive syndromeSmoking, cocaine use, uterine myoma?

Etiology • Uncertain (primary cause) • Risk factors 1. Increased age and parity 2. Vascular diseases: preeclampsia, chronic hypertension, renal disease. 3. Mechanical factors: trauma, intercourse, polyhydramnios, 4. Supine hypotensive syndrome 5. Smoking, cocaine use, uterine myoma

PathologyMain changehemorrhage into the decidua basalis → deciduasplits → decidural hematoma → separationcompression, destruction of the placentaadjacenttoitTypesrevealed abruption, concealed abruptionmixed typeUteroplacentalapoplexy子宫胎盘卒中

Pathology • Main change hemorrhage into the decidua basalis → decidua splits → decidural hematoma → separation, compression, destruction of the placenta adjacent to it • Types revealed abruption, concealed abruption, mixed type • Uteroplacental apoplexy 子宫胎盘卒中

CONCEALEDHEMORRHAGEPARTIALPLACENTA PREVIAPLACENTALABRUPTIONEXTERNALHEMORRHAGEMOOIFIEDFROMEHB

Pathology

MOOIFIEDFROMBIRCH

ManifestationVaginal bleeding companied with abdominalpainMild typeabruption≤ 1/3, apparent vaginal bleedingSevere typeabruption > 1/3, large retroplacental hematoma.vaginal bleeding companied by persistentabdominal pain, tenderness on the uterus.change of fetal heart rate.shock and renalfailure

Manifestation • Vaginal bleeding companied with abdominal pain • Mild type abruption≤ 1/3, apparent vaginal bleeding • Severe type abruption > 1/3, large retroplacental hematoma, vaginal bleeding companied by persistent abdominal pain, tenderness on the uterus, change of fetal heart rate. shock and renal failure

Adjunctive ExaminationUltrasonographyPosition of placenta, severity of abruptionsurvival of fetusSigns:retroplacental hematoma3.Negative findings do not exclude placentalabruptionLaboratory examinationconsumptive coagulopathy:Rt, DIC2Function of liver and kidney

Adjunctive Examination • Ultrasonography 1. Position of placenta, severity of abruption, survival of fetus 2. Signs: retroplacental hematoma 3. Negative findings do not exclude placental abruption • Laboratory examination 1. consumptive coagulopathy: Rt, DIC 2. Function of liver and kidney

Diagnosissign and symptomVaginal bleedingUterine tenderness or back painFetal distressHighfrequency contractionsHypertonusIdiopathic preterm laborDead fetus

Diagnosis • sign and symptom 1. Vaginal bleeding 2. Uterine tenderness or back pain 3. Fetal distress 4. High frequency contractions 5. Hypertonus 6. Idiopathic preterm labor 7. Dead fetus