产后出血2010(北医三院八年制临床医学课件)优质PPT.ppt
- 文档编号:15548176
- 上传时间:2022-11-04
- 格式:PPT
- 页数:44
- 大小:1.37MB
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》由会员分享,可在线阅读,更多相关《产后出血2010(北医三院八年制临床医学课件)优质PPT.ppt(44页珍藏版)》请在冰豆网上搜索。
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
- 配套讲稿:
如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。
- 特殊限制:
部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。
- 关 键 词:
- 产后 出血 2010 北医三院 八年 临床医学 课件