中国医科大学妇产科学英文课件 placental adortion.pptVIP

胎盘早剥 Definition After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption Etiology Vascular injury PIH syndrome chronic renal disease mechanical factors twins polyhydramnios short umbilical cord suddenly rising of the uterus venous pressure Pathophysiology The hemorrhage in the decidua forming hematoma behind placenta separate from wall of the uterus Classification A revealed abruption B concealed abruption C mixed hemorrhage 病 例 王铭，女，27岁，以“停经九个月，胎动五个月，突发性下腹痛伴阴道流血一小时”为主诉入院。平素月经规律，早孕 反应不明显，孕18周觉胎动，活跃至今，一小时前无明显诱因突发下腹痛，阴道 少量流血，鲜红，无意识模糊等表现。 查体：T37.2℃，P21次/分，BP85/55mmHg，心肺听诊无异常，腹 膨隆，孕足月腹， 纵产式腹肌紧张，子宫易激惹，右下腹有一局限性压痛点，阴道流血少量。 实验室检查：血常RBC2OO×1012/L，HGB8.7g/L,WBC11.4×109。 辅助检查：B超示BPD9.5cm，FL7.4 cm,胎盘位于后壁，与子宫间见一个3× 5cm 低回声区，未见胎心反射。 Clinical manifestations Mild type during labor revealed abruption ＜1/3 in size vaginal bleeding slight abdominal pain uterus is soft fetal position is clear fetal heart sounds is clear Clinical manifestations Severe type PIH symptoms concealed or mixed abruption ＞1/3 in size a lot of blood uterus enlarged rapidly increasing pain pallor out of proportion to amount of vaginal bleeding fetal position is not clear fetal heart sound disappear Assistant examination B-ultrasound examination laboratory findings A the degree of anemia B funtion of coagulation Diagnosis History signs examination assistant examination Differential diagnosis