产后出血2010(北医三院八年制临床医学课件)优质PPT.ppt

产后出血2010(北医三院八年制临床医学课件)优质PPT.ppt

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WilliamsObstetrics,21sted.,2001PPHistheleadingcauseofdeathrelatedtopregnancyworldwide11Majorcausesofdeathforpregnancywomen（maternalmortality）llPostpartumhemorrhage（28%）llheartdiseasesllpregnancy-inducedhypertensionll（orAmnioticfluidembolism）llinfection22DefinitionofPPHllTheearlyPPHisdefinedasabloodlossexceeding500mlafterdeliveryoftheinfant2cminlengthandbeactivelybleedinglllacerationofvaginalandperineumEtiology/prediction/prevention/management1919Record:

llPulseshockindexllbloodpressurellmaternalheartratellcentralvenouspressurellurineoutputEtiology/prediction/prevention/management2020Labtests:

llHb,llBT（bleedingtime）,CT（clottingtime）,llplateletscountllfibrinogenllprothrombintimeandpatialthromboplastintimellFDPllwomensbloodgroupandcross-matchingEtiology/prediction/prevention/management2121Treatment:

llthekeyiscorrectingthecoagulationdefectllresuscitationmustbestartedassoonaspossiblellinfusionofcrystalloid（saline）andDextranisstartedfirstlywhilearrangingthebloodtransfusionllbloodtransfusionisessentialllinfusionofredcells,platelets,freshfrozenplasma,FDP,clottingfactors,Etiology/prediction/prevention/management2222PerineumvaginalandcervicallacerationllonlyskinandaminorpartoftheperinealbodyllperinealbodyandvaginallanalsphincterandanalcanalEtiology/prediction/prevention/management2323StimulationofuterinecontractionllMassageofuterusthroughtheabdomenandbimanualcompressionllintrauterinepackingEtiology/prediction/prevention/management2424Surgicaltherapyllcausinguterinecontractionorcompressionlltamponadetheuterinecavitylldecreasebloodsupplytotheuterusllremovetheuterusll.Etiology/prediction/prevention/management2525SurgicalmethodsIfmassageandagentsareunsuccessful:

llLigationorembolizationoftheuterinearteriesllHysterectomyEtiology/prediction/prevention/management2626adherenceofplacenta（accretaincretapericreta）Etiology/prediction/prevention/management2727PotentialcomplicationsofPPHllPostpartuminfectionllAnemiallTransfusionhepatitis,llSheehanssyndromellAshermanssyndromeThebestmanagementofPPHispreventionEtiology/prediction/prevention/management2828ResuscitationforPPHllcallanassistantllresuscitatethepatientvigorouslyWhatisthestateofherperipheralcirculation?

Howmuchbloodhasshelost?

Isitclottingnormallyinthereceiverusedtocollectit?

Whathasbeendonesofar?

Monitorthevolumeofbloodshecontinuestoloseherperipheries,pulseandbloodpressure,andherurineoutput.2929Summary:

remember4Tsll“TONE”“TONE”llRuleoutUterineRuleoutUterineAtonyAtonyllPalpatefundus.Palpatefundus.llMassageuterus.Massageuterus.llOxytocin20U/500cc.Oxytocin20U/500cc.llProstaglandinProstaglandinllHemabateHemabateIMq15minIMq15min3030Summary:

remember4Tsll“Tissue”“Tissue”llR/OretainedplacentaR/OretainedplacentallInspectplacentaforInspectplacentaformissingcotyledons.missingcotyledons.llExploreuterus.Exploreuterus.llTreatabnormalTreatabnormalimplantation.implantation.3131Summary:

remember4Tsll“TRAUMA”“TRAUMA”llR/ocervicalorvaginalR/ocervicalorvaginallacerations.lacerations.llObtaingoodObtaingoodexposure.exposure.llInspectcervixandInspectcervixandvagina.vagina.llWorryaboutslowWorryaboutslowbleeders.bleeders.llTreathematomas.Treathematomas.3232Summary:

remember4Tsll“THROMBIN”“THROMBIN”llChecklabsifChecklabsifsuspicious.suspicious.3333Case-2ll37ys,37ys,multiparitymultiparity,wasadmittedinher40,wasadmittedinher40+2+2wksforwksforirregularcontractionwithoutanyabnormalsign.irregularcontractionwithoutanyabnormalsign.llTwohrslater,thecontractionbecamestrongerandTwohrslater,thecontractionbecamestrongerandmembranesrupturedwhenhwithmembranesrupturedwhenhwithmeconiummeconium-stained-stainedamnioticfluidIamnioticfluidIdegree.degree.ll7:

337:

33cyanochroiacyanochroiahappenedwithbreathlessandlosshappenedwithbreathlessandlossofconsciousnessinasecond.ofconsciousnessinasecond.3434Whatisthediagnosisll8:

20pmstill-birthweight3.2kg.llPPHemergedassoonasplacentadeliveredwithoutanyclot.llThepatientwasinthestateofunconsciousnessandbecamepale3535HysterectomyllHysterectomywasdonesoonafterresuscitation.llTheamountwasabout4000ml.llRedcellwastransfused1600ml,freshplasma400ml,platelet20u,cryoprecipitate10u.llTransfusionwascontinuedafterOP1800ml.3636ll，Hb38g/L,APTT43.4秒，PT45.0（正常11-14sec）,PT比例3.52（正常0.85-1.15），Fbg0.976g（正常2-4g/L）,APTT不凝，TT44.Tsec（正常14-21sec）。

FDP（+），D-2聚集体（+），3P试验（+）。

尿常规Pro2+,比重1.000,RBC10-15/HP,可见颗粒管型。

3737ll术术后后4141小小时时拔拔除除气气管管插插管管，并并停停用用多多巴巴胺胺，生生命命体体征征平平稳稳。

术术后后4040小小时时发发现现左左上上肢肢皮皮肤肤感感觉觉减减退退，运运动动受受限限。

头头部部MRIMRI：

左左侧侧小小脑脑半半球球、双双侧侧枕枕、顶顶