妇产科学Normal puerperium(Postpartum care)PPT课件PPT资料.ppt

妇产科学Normal puerperium(Postpartum care)PPT课件PPT资料.ppt

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Topicstoday,NormalpuerperiumDiseasesofpuerperiumEctopicpregnancyAbortionZhaoAiminMD.PhD.,Normalpuerperium（Postpartumcare）,Puerperium,6weeksperiodsafterbirththereproductivetractreturntoitsnormal,non-pregnancystatetheinitialpostpartumvisitisscheduledat42thdays,Physiologyofthepuerperium,Involutionoftheuterusreturntothepelvisbyabout2weeksbeatnormalsizeby6weekstheweightchangesofuterus1000gimmediatelyafterbirth500g1weeksafterbirth300g2weeksafterbirth50g6weeksafterbirth,Cervix:

@#@Ithasreformedwithinseveralhoursofdeliveryitusuallyadmitsonlyonefingerby1weekstheexternalosisfish-mouth-shapeditreturntoitsnormalstateat4weeksafterbirth,Ovarianfunctionthetimeofovulationis3monthsinnon-breast-feedingwomenCardiovascularsystem:

@#@returntonormalafter2-3weeks,ClinicalmanifestaionofpuerperiumTislessthan38?

@#@InvolutionofuterusAfter-painsonsets1-2daysandmaintant2-3days,lochiadischargecomesfromtheplacentalsiteandmaintantsfor4-6weeksLochiarubraberedincolorforthefirst3-4daysLochiaserosamaintantsfor2weeksLochiaalbamaintantsfor2-3weeks,Managementofthepuerperium,Maternal-infantbondingroominginUterinecomplicationspostpartumhemorrhage,infection,theamountoflochiaBowelmovementUrinationCareoftheperineum,ManagementofbreastBreast-feedingthebenefitsofbreast-feedingincreasetheconversationdecreasethecostimproveinfantnutritionandprotectagainstinfectionandallergicreactionuteruscontraction,DiseasesofpuerperiumPuerperalinfectionLatepuerperalhemorrhagePostpartumdepressionpuerperalheatstroke,PuerperalinfectionPuerperalinfectionGenitalinfectedbypathogenicmicroorganismduringlaborandpuerperalperiodTheincidenceisabout1%-7.2%Itisoneofthefourkindsofcauseswhichresultinmaternalmortality,PuerperalmorbidityTofmaternalmorethan38?

@#@occurstwicewithin24h-10daysafterbirthItmaybecausedbypueperalinfection,urogenitalinfectionetal.,InductionfactorsofpuerperalinfectionGeneralasthenia,DystrophyAnemia,SexualintercoursePROM,InfectionofamnoticcavityObstetricoperationHemorrhagepreandpostpartum,ThekindsofpathogenBata-hemolyticstreptococcusAnaerobicstreptococcusAnaerobicbacillusStaphylococcusBacilluscoli,PathologyandclinicalmanifestationAcutevulvitis,vaginitis,cervicitisAcuteendometritis,myometritisAcuteinflammationofpelvicconnectivetissure,Salpingitis,PeritonitisThrombophlebitisPyemiaandhematosepsis,DiagnosisandtreatmentsupportingtreatmentDeletetheinductionfactorsBroad-spectrunantibioticExpectanttreatment,LatepuerperalhemorrhageExcessivebleedinginpuerperalperiodafter24hdeliveryItcanoccursuddenandprofuseItcanoccurslowlybutprolongedandpersistent,EtiologyandclinicalmanifestationRetainedplacentaandmembraneLochiarubraprolongedBloodlossrepeatedorbleedingexcessivesuddendlyDys-involutionoftuerusRelaxofcervixPlacentatissurecanbepalpable,RetaineddeciduaInfectionoftheplacentaattachmentareaDys-involutionofuterusFissurationofutrineinsisionpostcesareanTrophoblastictumorpostpartumSubmucusmyoma,DiagnosisandtreatmentsupportingtreatmentDeletetheetiologicfactorsBroad-spectrunantibioticExpectanttreatment,EctopicpregnancyDefinitionImplantationoutsideoftheuterinecavityistermedectopicpregnancyItisaconditionthatsignificantlyjeopardizesthemotherbecausecatastrophicbleedingmayoccurwhentheimplantingpregnancyerodesbloodvesselsorrupturesofthetubalwall,ImplantlocationsTubal95%（80%ampullaryportion）Ovarian1%Abdominal1-2%Cervical0.15%Cornual2%,EtiologySalpingitishave6-foldincreasetheriskofectopicpregnancyOperationoftubalIUD（intrauterinedevice）DysfunctionoftubalOrther:

@#@endometriosis,OutcomesofectopicpregnancyTubalabortion8-12WeeksampullaryportionRuptureoftubalpregnancy5weeksisthmicportionTubalabortionwithsubsequentimplantationonanintraperitonealstructureforexampleliverpregnancy,ClinicalmanifestationofectopicpregnancyAmenorrhea70-80%6-8weeksAbdominalandpelvicpainthemostcommonsymptom,whichispresentinnealyallpatients.PainisaresultofdistentedoftubalandirritationofperitoneumbybloodIrregularvaginalbleedingresultsfromthesloughingofthedeciduaShockresultfromamountofbloodlossAbdominalmass,PhysicalfindingsintubalpregnancyGeneralfindings:

@#@AnemicorpalefacepulseincreasedBPdecreasedT38degree,AbdominalexaminationdistentionandtendernesswithorwithoutreboundDecreasedbowelsoundShiftingdullnesspositivemass,PelvicexaminationSlightlyopencervixwithbleedingCervicalmotiontendernessAdnexaltendernessAdnexalmassTheuterussizemaybenormalorenlarged,DiagnosticproceduresTypicalcasescanbedeterminedeasyEarlyectopicpregnancyorunrupturetypedifficultyItisnessesar