版權(quán)說(shuō)明：本文檔由用戶提供并上傳，收益歸屬內(nèi)容提供方，若內(nèi)容存在侵權(quán)，請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡(jiǎn)介
PlacetalPreviaLongXiaoyu龍曉宇XuanWuHospital宣武醫(yī)院1.PlacetalPreviaLongXiaoyuCase1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase12.Case1.30G3P2at32weeksWhatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?3.Whatismostlikelydiagnosis?.Whatarethemostcommoncausesof
AntepartumHemorrhage?6.WhatarethemostcommoncauseCOMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselrupture
CervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorder
Unknown(byexclusionoftheabove)7.COMMONCAUSESPlacentaPreviaUNPlacentalPrevia8.PlacentalPrevia8.UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives9.UnderstandthatplacentaprevDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；
International：0.5%~0.9%。PlacentalPrevia10.Definedastheinferioredgeo“theplacentaoverlyingtheinternalosofthecervix”11.“theplacentaoverlyingtheiClassification12.Classification12.ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentaprevia13.ClassificationComplete(centralWhataretheriskfactorsforplacentalPrevia?Question
14.WhataretheriskfactorsforETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGY15.ETIOLOGYIncreasedmaternalageManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentation16.ManifestationClinicalPresentaManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.17.ManifestationTheclassTotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia
BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia
BetweentotalandmarginalMarginalplacentaprevia
Late(37-40WKSorinlabor)Lessbleeding18.TotalplacentapreviaPartialp
symptom
Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.
Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.19.symptomSeverebloodlComplicationofmother
andfetus
BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredelivery20.Complicationofmother
HowtodiagnosetheplacentalPrevia?Question
21.HowtodiagnosetheplacentalPatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”22.PatientHistory–PlacentaPrePhysicalExam–PlacentaPrevia
TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknown23.PhysicalExam–PlacentaPreviAuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI
PosteriorpreviaHighcostLimitedavailability24.AuxiliaryexaminationB-ultr25.25.Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowall26.Laboratory–PlacentaPreviaHeDifferentiation
diagnosisPlacentalabruptionvesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma
27.DifferentiationdiagnosisPlace28.28.Management
Expectantdelivery
aimatachievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.29.ManagementExpectantdelivery2Management
expectanttreatment
Indication:
FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g
Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfection30.ManagementexpectanttreatmenTerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement
31.TerminationofpregnancyManage32.32.Vaginaldelivery
Marginalplacentaprevia
VaginalbleedingislimitedManagement
33.VaginaldeliveryManagement33.AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement
34.Management34.PlacentaPrevia
ManagementSeverebleedingCaesareansectionModeratebleedingGestation>34<34ResuscitateSteroidsUnstableStableResuscitateMildbleedingGestation<36Conservativecare>36Management
35.PlacentaPrevia
ManagementSeveManagementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentation36.Managementofplacentaprevia?UltrasoundexaminationPlacenta
previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestation37.UltrasoundexaminationPlacentEachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1B38.EachofthefollowingisarisEachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2B39.EachofthefollowingisatyA33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingisthebestmanagementforthispatient?A)Inductionoflabor;B)Tocolysisoflabor;C)Cesareandelivery;D)ExpectantmanagementE)IntrauterinetransfusionExercise3C40.A33-year-oldwomanat37weeA22-year-oldG1P0womanat34week’sgestationpresentswithmoderatevaginalbleedingandnouterinecontractions.Whichofthefollowingsequenceofexaminationsismostappropriate?A)Speculumexamination,ultrasoundexamination,digitalexamination;B)Ultrasoundexamination,digitalexamination,speculumexamination;C)Digitalexamination,ultrasoundexamination,speculumexamination;D)Ultrasoundexamination,speculumexamination,digitalexamination;Exercise4D41.A22-year-oldG1P0womanat34An18-yeas-oldwomanisnotedtohaveamarginalplacentapreviaonanultrasoundexaminationat22week’sgestation.Whichofthefollowingisthemostappropriatemanagement?A)Schedulecesareandeliveryat39weeks;B)Scheduleanamniocentesisat36weeksanddeliverbycesareanifthefetallungsaremature;C)ScheduleanMRIexaminationat35weekstoassessforpossiblepercretainvolvingthebladder;D)Reassessplacentalpositionat32weeksE)RecommendterminationofpregnancyExercise5D42.An18-yeas-oldwomanisnotedUnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives43.Understandthatplacentaprev44.44.后面內(nèi)容直接刪除就行資料可以編輯修改使用資料可以編輯修改使用資料僅供參考，實(shí)際情況實(shí)際分析45.后面內(nèi)容直接刪除就行45.感謝您的觀看和下載Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield46.感謝您的觀看和下載TheusercandemonstrPlacetalPreviaLongXiaoyu龍曉宇XuanWuHospital宣武醫(yī)院47.PlacetalPreviaLongXiaoyuCase1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase148.Case1.30G3P2at32weeksWhatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?49.Whatismostlikelydiagnosis?.Whatarethemostcommoncausesof
AntepartumHemorrhage?52.WhatarethemostcommoncauseCOMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselrupture
CervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorder
Unknown(byexclusionoftheabove)53.COMMONCAUSESPlacentaPreviaUNPlacentalPrevia54.PlacentalPrevia8.UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives55.UnderstandthatplacentaprevDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；
International：0.5%~0.9%。PlacentalPrevia56.Definedastheinferioredgeo“theplacentaoverlyingtheinternalosofthecervix”57.“theplacentaoverlyingtheiClassification58.Classification12.ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentaprevia59.ClassificationComplete(centralWhataretheriskfactorsforplacentalPrevia?Question
60.WhataretheriskfactorsforETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGY61.ETIOLOGYIncreasedmaternalageManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentation62.ManifestationClinicalPresentaManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.63.ManifestationTheclassTotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia
BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia
BetweentotalandmarginalMarginalplacentaprevia
Late(37-40WKSorinlabor)Lessbleeding64.TotalplacentapreviaPartialp
symptom
Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.
Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.65.symptomSeverebloodlComplicationofmother
andfetus
BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredelivery66.Complicationofmother
HowtodiagnosetheplacentalPrevia?Question
67.HowtodiagnosetheplacentalPatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”68.PatientHistory–PlacentaPrePhysicalExam–PlacentaPrevia
TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknown69.PhysicalExam–PlacentaPreviAuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI
PosteriorpreviaHighcostLimitedavailability70.AuxiliaryexaminationB-ultr71.25.Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowall72.Laboratory–PlacentaPreviaHeDifferentiation
diagnosisPlacentalabruptionvesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma
73.DifferentiationdiagnosisPlace74.28.Management
Expectantdelivery
aimatachievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.75.ManagementExpectantdelivery2Management
expectanttreatment
Indication:
FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g
Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfection76.ManagementexpectanttreatmenTerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement
77.TerminationofpregnancyManage78.32.Vaginaldelivery
Marginalplacentaprevia
VaginalbleedingislimitedManagement
79.VaginaldeliveryManagement33.AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement
80.Management34.PlacentaPrevia
ManagementSeverebleedingCaesareansectionModeratebleedingGestation>34<34ResuscitateSteroidsUnstableStableResuscitateMildbleedingGestation<36Conservativecare>36Management
81.PlacentaPrevia
ManagementSeveManagementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentation82.Managementofplacentaprevia?UltrasoundexaminationPlacenta
previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestation83.UltrasoundexaminationPlacentEachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1B84.EachofthefollowingisarisEachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2B85.EachofthefollowingisatyA33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingis
溫馨提示
- 1. 本站所有資源如無(wú)特殊說(shuō)明，都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等，如果需要附件，請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙，網(wǎng)頁(yè)內(nèi)容里面會(huì)有圖紙預(yù)覽，若沒(méi)有圖紙預(yù)覽就沒(méi)有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 人人文庫(kù)網(wǎng)僅提供信息存儲(chǔ)空間，僅對(duì)用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理，對(duì)用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯，并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容，請(qǐng)與我們聯(lián)系，我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。
最新文檔
- 2025年公用設(shè)備工程師之專業(yè)知識(shí)（動(dòng)力專業(yè)）題庫(kù)及答案
- 小學(xué)語(yǔ)文課件《種花與分享快樂(lè)》
- 《江南曲周杰倫》課件
- 微量營(yíng)養(yǎng)素與健康互動(dòng)：課件中的元素奧秘
- 掌握色彩測(cè)量在紡織品中的應(yīng)用試題及答案
- 中學(xué)生宿舍樓建設(shè)項(xiàng)目可行性分析報(bào)告
- 優(yōu)化課間休息環(huán)境的有效策略與實(shí)踐路徑
- 廣告設(shè)計(jì)師團(tuán)隊(duì)合作試題及答案
- 推動(dòng)學(xué)校內(nèi)涵式發(fā)展行動(dòng)方案
- 現(xiàn)代康復(fù)技術(shù)更新版課件
- 某危廢處置公司事故風(fēng)險(xiǎn)辨識(shí)、評(píng)估報(bào)告
- 《神經(jīng)外科顯微手術(shù)機(jī)器人平臺(tái)關(guān)鍵技術(shù)研究》
- 隧道應(yīng)急救援培訓(xùn)
- GB/T 44713-2024節(jié)地生態(tài)安葬服務(wù)指南
- 2024年大學(xué)生求職面試技巧培訓(xùn)課件
- 一年級(jí)家長(zhǎng)會(huì)課件2024-2025學(xué)年
- 省級(jí)啤酒代理權(quán)合同
- DB11∕T 1513-2018 城市綠地鳥類棲息地營(yíng)造及恢復(fù)技術(shù)規(guī)范
- 綜合實(shí)踐課件高中
- 工程質(zhì)量檢測(cè)監(jiān)理制度
- DISC性格與能力測(cè)試題及答案解析
評(píng)論
0/150
提交評(píng)論