产后出血2010(北医三院八年制临床医学课件)(1).ppt

Etiology/prediction/prevention/management Etiology/prediction/prevention/management “Obstetrics is Bloody Business”* Major causes of death for pregnancy women（maternal mortality) Postpartum hemorrhage（28%) heart diseases pregnancy-induced hypertension (or Amniotic fluid embolism ) infection Definition of PPH The early PPH is defined as a blood loss exceeding 500ml after delivery of the infant 24 h The late PPH: occurs after 24 hour of delivery to 6 weeks Major causes Uterine atony (90%) Lacerations of the genital tract(6%) Retained placenta(3%-4%) Coagulation defects (blood dyscrasia) (4T: tone, tissue, trauma, thrombin) 1. Uterine atony Local factors: Overdistention of the uterine Condition that interfere with contraction (leiomyoma) Complications (PIH, anemia, placenta previa) Systemic factors: Nervous Drugs Abnormal labor History of previous PPH Preeclampsia, abnormal placentation Pathology Contraction constricting the spiral arteries Preventing the excessive bleeding from the placenta implantation site Uterine atony give rise to PPH when no contraction occur Main complain Have heart palpitations Feel faint Lightheaded Breathless… 2. Lacerations of the genital tract Causes: Instrumented delivery (forceps) manipulative delivery (breech extraction, precipitous labor, macrosomia) Types: perineum laceration vaginal laceration cervical laceration 3. Retained placenta Separation and explosion of placenta is caused by strong uterine contraction Placenta tissue remaining in the uterus prevent adequate contraction and predispose to excessive bleeding 4. Coagulation defects Acquired abnormality in blood clotting: abruption placenta, amniotic fluid embolism severe preeclampsia Congenital abnormality in blood clotting: thrombocytopenia severe hepatic diseases leukemia disseminated intravascular coagulopathy (DIC) if bleeding persists in spite of all other treatment described, DIC should be suspected the blood passing from the genital tract is not cl