1、产前出血,前置胎盘 胎盘早剥 帆状胎盘血管前置 宫颈息肉 宫颈糜烂 外伤 疤痕子宫破裂 肿瘤,前置胎盘,定义：胎盘部分或全部覆盖宫内口。完全性 totalis部分性 partialis边缘性 marginalis 发生率：0.5% -1% of all births. 高危因素：剖宫产史(x 6)- 多产(x 2.6) 先前宫腔操作史-吸烟,完全性,完全性（圆盘型）,部分性,边缘性MARGINALIS,前置胎盘,临床特点:母源性无痛性阴道流血 painless bleeding of maternal origin 诊断:1. 超声Sonography 2.阴窥If cervical os d
2、ilated cautious inspection 合并症:胎盘早剥 ,胎位异常,产后出血 处理： 卧床、防栓塞 等 Bed rest, Thrombosis prophylaxis,分娩方式DELIVERY MODUS,剖宫产Practically all women do need cesarean section. 注意点:1.胎儿早产又无分娩指征（观察）The fetus is preterm and there is no indication for delivery.(observe)2.胎儿成熟母出血不止（c.s)The fetus is mature and the ble
3、eding does not stop.(cesarean S)3.孕妇临产The patient is in labor (cesarean S)4.出血严重胎儿不成熟（c.s)The bleeding severe,and the fetus immature (cesarean S),疤痕子宫、前置胎盘、胎盘植入,前置胎盘、胎盘植入,前置胎盘产前出血,胎盘早剥 PLACENTAL ABRUPTION,孕产妇死亡的主因One of the leading causes of the perinatal mortality 发生率: 0.5% - 1% of all deliveries 病
4、生Pathophysiology: 因腹部外伤、母缺氧或缺血以及感染，绒毛从蜕膜板分离。,出血类型,临床分级CLINICAL STAGING,Grade 0: 无症状，仅从超声和产后检查诊断。asymptomatic;diagnosis often postnatal or by sonography Grade 1 :有外、内出血迹象，母循环系统无变化，无胎儿窘迫。scant external No fetal distress.,Grade 2 :严重出血和胎儿窘迫heavy bleeding (external internal) Fetal distress (CTG ) Grade
5、3 :严重出血、子宫剧痛和休克伴有DIC和胎儿濒死。severe external maternal shock in 30% of cases associated with coagulation disorders.,高危因素:,先前有胎盘早剥Previous abruption (x 10) 宫肌瘤Myoms 子宫纵膈Uterusseptum 母亲疾病：高血压、栓塞性疾病、Maternal diseases: Hypertension, Thrombophilia , Hyperhomocysteinemia 胎盘异常：环状Abnormal Placentation :for exam
6、ple: Plac. Circumvallata滥用尼古丁和可卡因Nicotine & Cocaine Abuse 腹部外伤Blunt Abdominal Trauma,诊断 DIAGNOSIS,疼痛性阴道出血Painfull vaginal bleeding 板状腹Tetanic contractions of uterus 胎心监护异常Pathological CTG 超声图像Sonography: (敏感性 Sensitivity : 50%),处理,无症状No symptoms(no bleeding ) :观察母胎情况observe the mother and the fetus
7、. 严重出血胎儿存活：C.S。Severe bleeding +the fetus is alive: Cesarean section. 出血胎儿死亡：人工破膜成份输血阴道分娩引产，但若出血太严重则剖宫产。Clinical symptoms (bleeding)+the fetus is dead : Amniotomy +packed red cells+coagulation factors +labor induction (vaginal birth),but if the bleeding too severe then cesarean section,子宫内部出血 BLEEDING INTRAPARTAL,见红BLOODY SHOW血管前置VASA PRAEVIA帆状胎盘前置INSERTIO VELAMENTOSA胎盘早剥ABRUPTIO PLACENTAE子宫破裂UTERINE RUPTURE,血管前置 若人工破膜后出血要想起该病！,帆状胎盘血管前置 INSERTIO VELAMENTOSA,帆状胎盘 INSERTIO VELAMENTOSA,产前出血入院7次，多次超声（）。孕39周，临床出血120mlC.S.,
