placentalabruption2022/11/111

At20weeks’gestationlaterordeliveryterm,wholeorpartialabruptionhavetakenplacebeforesecondstageoflaborforplacentainnormalposition.

Itcomplicates0.462.1%ofallpregnancies.Theperinatalmortalityrateduetoplacentalabruptionis20%-35%presently.Definition2022/11/1122022/11/1131.Vasculardisease

hypertensivedisorderscomplicatingpregnancy（preeclampsia子癇前期）

hypertension

nephrosis（腎?。〦tiology2022/11/114Etiology2.mechanicalfactors

trauma

extremeshortnessofumbilicalcord（臍帶過(guò)短）amniocentesis

（羊膜穿刺術(shù)）2022/11/115Etiology3.uterinevolumesuddenlynarrowuterinecavitypressuredrop

fetalpresentationdescentquickly

polyhydramnios（羊水過(guò)多）ruptureofmembrane

twins，thefirstonelaborrapidly2022/11/116Etiology4.Venouspressureofuterinesuddenlyheighten

supinehypotensivesyndrome（仰臥位低血壓綜合癥）Venouspressureofuterinesuddenlyheighten

deciduavein’sbedcongestionorruptureplacentalabruption2022/11/117Etiology5.Theothers:Cocaineabuse,smoking,etc.2022/11/118

Basalpathophysiology

：basaldeciduableedinghematomaofposteroplacenta（胎盤后血腫）adhesionplaceabruption1.UteroplacentalapoplexyBleedingintothemyometriumoftheuterusgivingadiscoloredappearancetotheuterinesurface.(calledCouvelairuterus,too庫(kù)弗萊爾子宮)Pathophysiology

2022/11/1192022/11/11102022/11/11112.Coagulationdisorders

Placentaabruptionresultsfromreleaseofthromboplastin(促凝血酶原激酶)fromthedisruptedplacentaandthesubplacentaldeciduaintothematernalcirculation,causeaconsumptivecoagulopathy（消耗性凝血?。?Pathophysiology2022/11/1112

Categories

1.Revealedabruption

Bloodextenddownwardtowardthecervix,resultinginanexternalorrevealedhemorrhage.2022/11/11132022/11/1114

Categories2.Concealedabruption

Bloodmaydissectupwardtowardthefundus,resultinginanconcealedhemorrhage.2022/11/11152022/11/1116Categories3.mixedabruption2022/11/1117clinicalmanifestation

Cardinalsymptom

：suddenabdominalpainandsomevaginalbleeding.

2022/11/1118clinicalmanifestation

ⅠⅡⅢ

area

1/31/3左右1/2categories

revealed

concealed/revealedconcealedsymptom

litterbleedingsuddenabdominalpain

bleedingornobleeding

noabdominalpaindiscrepancyofanemia/bleeding

classicanemia

noanemiadiscrepancybleeding/general

sign

uterinesoft，notendernessuterine>gestationweeksuterinehardnesslikesboard,tenderness,，

uterine/gestationweeksconformityfundusrise，uterine>gestationweeks

fetusgoodtenderness,fetusalivefetalhearttonesdisappear

postpartumcheckplacentauterinecontractionuterinecontractionno

isintermissionintermission,shock2022/11/11191.Ultrasound：auxiliaryexamination

2022/11/11201.Ultrasound：2022/11/1121auxiliaryexamination2.laboratoryexamination

DICexamination

Fibrinolysisconfirmeddiagnosistest

（纖維蛋白溶解確診試驗(yàn)）

2022/11/1122

Diagnosisaccordingto:

Casehistory,symptom,signandultrasound,itcanbediagnosis.2022/11/11231DICandcoagulationdisorders

2.Postpartumhemorrhage.3.Acutekidneyfailure

（急性腎功衰）.4Amnionicfluidembolism；amnioticfluidembolism.（羊水栓塞）5.Fetaldeath.Complication2022/11/1124Therapeuticprinciple:Countershock（抗休克）

PreventionandcureDIC,acutekidneyfailure

.

Terminationofpregnancyintime.

Treatment2022/11/1125TreatmentTerminationofpregnancy:

vaginaldelivery:Ⅰ,inshorttime

cesareansection:Ⅱ,Ⅲ,Ⅰdegreewithfetaldistress（胎兒窘迫）;fetaldeathcannotd