(婦產(chǎn)科學(xué)課件）8.3（參考翻譯）Placenta Previa

1、(婦產(chǎn)科學(xué)課件）8.3（參考翻譯）Placenta Previau Incidence 發(fā)生率發(fā)生率 0.24%1.57% (our country) 0.5%0.90% (other countries)It is the major reason of hemorrhage in the third trimester pregnancy 這是晚期妊娠出血的主要原這是晚期妊娠出血的主要原因因General Consideration 概論概論General Consideration 概論概論uUncertain 不明不明uHigh risk factors 高危因素高危因素: 1.mat

2、ernal 母親的母親的 age: 35 years 2.multiparity 經(jīng)產(chǎn)的經(jīng)產(chǎn)的 3.prior cesarean delivery 剖腹產(chǎn)剖腹產(chǎn): 5 times 5倍幾率倍幾率 4.smoking 吸煙吸煙Causes 成因成因 1. Endometrial abnormality 子宮內(nèi)膜功能不全子宮內(nèi)膜功能不全 1)Scared or poorly vascularized endometrium in the corpus. 受驚嚇或器官內(nèi)血受驚嚇或器官內(nèi)血管內(nèi)膜發(fā)育不良（？）管內(nèi)膜發(fā)育不良（？） 2)Curettage 刮宮刮宮, Delivery 分娩分娩, CS

3、胎囊（？）胎囊（？）and infection of endometrium 子宮內(nèi)膜感染子宮內(nèi)膜感染 2. Placental abnormality 胎盤功能不全胎盤功能不全 1)Large placenta 巨大胎盤巨大胎盤 (multiple pregnancy 多胎妊娠多胎妊娠) 2)succenturiate lobe （副胎盤）（副胎盤） 3. Delayed development of trophoblast cell 滋養(yǎng)層細(xì)胞發(fā)育遲緩滋養(yǎng)層細(xì)胞發(fā)育遲緩Succenturiate placenta 副胎盤副胎盤Classification 分類分類uComplete pla

4、centa previa 完全性胎盤前置完全性胎盤前置 uPartial placenta previa 部分性胎盤前置部分性胎盤前置 uMarginal placenta previa 邊緣性胎盤前置邊緣性胎盤前置Complete PPPartial PPMarginal PPuLow-lying placenta（低置胎盤）（低置胎盤） The placenta is implanted 植入植入 in the lower uterine segment 子宮下段子宮下段 such that the placental edge 邊緣邊緣 does not reach the intern

5、al os 子宮內(nèi)口子宮內(nèi)口, but is in close proximity 接近接近 to it.Classification 分類分類Marginal PPLow-lying PClassification 分類分類uPernicious placenta previa（兇險(xiǎn)性前置胎盤）（兇險(xiǎn)性前置胎盤） previous c-section 前次剖腹產(chǎn)史（？）前次剖腹產(chǎn)史（？） + placenta previa 胎盤前置胎盤前置 placenta accreta 胎盤增生胎盤增生: 50%Manifestation 表現(xiàn)表現(xiàn)uSymptom 癥狀癥狀: Sudden , recu

6、rrently painless vaginal bleeding in third trimester. 位于妊娠晚期的突然的、反復(fù)發(fā)作的位于妊娠晚期的突然的、反復(fù)發(fā)作的無痛性陰道流血無痛性陰道流血CHARACTER of bleeding PainlessManifestation 表現(xiàn)表現(xiàn)u Unassociated to activity 與活動(dòng)無關(guān)與活動(dòng)無關(guān) , often occurs during sleep, or sleeps in a pool of blood.u A few nulliparas 未產(chǎn)婦未產(chǎn)婦 no bleeding.u Cause of bleedin

7、g Mechanical separation 機(jī)械分離機(jī)械分離 Placentitis 胎盤炎胎盤炎 Rupture of the venous in the decidua basalis 底蛻膜靜脈底蛻膜靜脈破裂破裂Manifestation 表現(xiàn)表現(xiàn)uThe time of onset of bleeding, the amount, the frequency is related to the types of placenta previa. 胎盤前置的出血時(shí)間、出血量、頻率與其種類相關(guān)胎盤前置的出血時(shí)間、出血量、頻率與其種類相關(guān)Types TimeFrequency Amoun

8、tComplete2832wmoremorePartial3236wmidmidMarginal36wlesslessSign 體征體征:uAbdominal findings 腹部表現(xiàn)腹部表現(xiàn): Uterus is soft, relaxed and no tender 子宮柔軟、放松、子宮柔軟、放松、無觸痛無觸痛. uContraction may be palpated 可能觸診到宮縮可能觸診到宮縮.uFetal heart tones maybe disappear 胎心音可能胎心音可能消失消失.Manifestation 表現(xiàn)表現(xiàn) Sign 體征體征:uAnemia or shock

9、 貧血或休克貧血或休克 (1)repeated bleeding 反復(fù)流血反復(fù)流血anemia (2)heavy bleeding 嚴(yán)重出血嚴(yán)重出血 shockuAbnormal fetal position 異常胎位異常胎位 (1)a high presenting part (2)breech presentation 臀先露臀先露(often)Manifestation 表現(xiàn)表現(xiàn)Diagnosis 診斷診斷uClinical symptoms and signs 臨床癥狀和體征臨床癥狀和體征uSonography 超聲波掃描術(shù)超聲波掃描術(shù): the most important diag

10、noses methodsimplest 最簡(jiǎn)單最簡(jiǎn)單, precise 精確精確, safest 最安全最安全Diagnosis 診斷診斷uClinical symptoms and signsuSonography: the most important diagnoses methodsimplest, precise, safestDiagnosis 診斷診斷uMRI: Useful but expensive, check the accreta 植入植入Diagnosis 診斷診斷uSpeculum examination 內(nèi)窺鏡檢查內(nèi)窺鏡檢查uVaginal examinatio

11、n 陰道檢查陰道檢查: seldom useduRectal examination 直腸檢查直腸檢查: useless and dangerousDiagnosis 診斷診斷uCheck the placenta 胎盤胎盤 and membrane 胎膜胎膜 after delivery: The distance from edge of placenta to the rupture 破裂破裂 of the fetal membranes 胎膜胎膜 is less than 7cm.Differential diagnosis 鑒別診斷鑒別診斷u Placental abruption

12、胎盤早剝胎盤早剝painful 疼痛疼痛 vaginal bleeding 陰道流血陰道流血 uterus tenderness 子宮壓痛子宮壓痛Differential diagnosis 鑒別診斷鑒別診斷Vascular previa 血管前置血管前置Cervix diseases 宮頸疾病宮頸疾病Effect to mother and fetus 母胎影響母胎影響uObstetric hemorrhage 產(chǎn)科出血產(chǎn)科出血 uPlacenta accreta 胎盤增生胎盤增生 uAnemia and infection 貧血和感染貧血和感染 uPremature delivery 早產(chǎn)

13、早產(chǎn) and perinatal fetus 圍產(chǎn)期胎兒圍產(chǎn)期胎兒 high mortality rate 高高死亡率死亡率Treatment principle 治療原則治療原則Principle 原則原則:uInhibit contraction 抑制宮縮抑制宮縮uControl bleeding 控制出血控制出血uCorrect anemia 糾正貧血糾正貧血uPrevent infection 防止感染防止感染uPromote fetal lung maturity 促進(jìn)胎兒肺成熟促進(jìn)胎兒肺成熟Treatment method 治療方法治療方法uExpectant treatment

14、期待療法期待療法uTermination of pregnancy 終止妊娠終止妊娠uEmergent transfer 緊急轉(zhuǎn)移（？）緊急轉(zhuǎn)移（？）Expectant treatment 期待療法期待療法Indication 適應(yīng)癥適應(yīng)癥: u34weeksuFetal weight 400ml) threaten to mother or fetusu36th weekuMarginal PP with bleeding too much, cant delivery immediatelyu36th week, fetal distress 胎兒窘迫胎兒窘迫 uFetus death 胎

15、兒死亡胎兒死亡 or severe malformation 嚴(yán)重畸形嚴(yán)重畸形Termination of pregnancy 終止妊娠終止妊娠uCesarean section 剖腹產(chǎn)術(shù)剖腹產(chǎn)術(shù) Complete and partial placenta previa Huge bleedinguVaginal delivery 陰道分娩陰道分娩 Marginal placenta previa Head presentation 頭先露頭先露 Progress of delivery satisfactory 分娩進(jìn)程順利分娩進(jìn)程順利Termination of pregnancy 終止妊

16、娠終止妊娠uTreat postpartum hemorrhage 產(chǎn)后出血產(chǎn)后出血. 1.Promote uterine contractions 促進(jìn)宮縮促進(jìn)宮縮. Oxytocin 縮宮素縮宮素, massage uterus 按摩子宮按摩子宮. Uterine B-lynch suture 背帶式縫合背帶式縫合.Pack uterine cavity with ribbon gauze 宮腔填塞紗布宮腔填塞紗布條條. 2.Uterine artery ligation 子宮動(dòng)脈結(jié)扎子宮動(dòng)脈結(jié)扎. 3.Subtotal hysterectomy 次全子宮切除次全子宮切除.Emergent transfer 緊急轉(zhuǎn)移緊急轉(zhuǎn)移upostpartum hemorrhage 產(chǎn)后出血產(chǎn)后出血uPernicious p