妇产科诊疗常规及技术操作规程.docx

妇产科诊疗常规及技术操作规程.docx

《妇产科诊疗常规及技术操作规程.docx》由会员分享，可在线阅读，更多相关《妇产科诊疗常规及技术操作规程.docx（200页珍藏版）》请在冰豆网上搜索。

妇产科诊疗常规及技术操作规程

XXXXX院

妇产科诊疗常规

及技术操作规程

XXXXXXXX院

二〇一七年一月修订

第一章产科疾病············································1

1、产前检查············································1

2、正常分娩·············································2

3、难产处理················································7

（1）产力异常···············································7

〔附〕子宫收缩环··········································7

（2）骨产道异常·············································11

（3）胎位及胎儿异常········································10

①枕后位（枕横位）········································10

②颜面位·················································11

③臀位···················································11

④横位···················································12

⑤巨大胎儿·············································13

⑥无脑儿················································13

⑦脑积水·················································14

4、妊娠病理···············································15

（1）妊娠高血压综合征······································15

（2）过期妊娠··············································18

（3）双胎··················································19

（4）胎儿宫内发育迟缓（IUGR）································20

（5）死胎··················································22

（6）羊水过少··············································22

（7）羊水过多··············································23

（8）前置胎盘··············································24

（9）胎盘早期剥离··········································26

（10）早产·················································27

（11）前次剖宫产············································28

（12）疤痕子宫·············································29

5、妊娠合并症·············································29

（1）妊娠合并贫血··········································29

（2）妊娠合并心脏病········································31

（3）妊娠合并心律失常······································33

（4）围产期心肌病··········································34

（J）妊娠合并卵巢肿瘤·······································34

（6）妊娠合并甲状腺功能亢进································35

（7）妊娠合并糖尿病········································36

（8）妊娠合并慢性肾炎······································37

（9）妊娠合并急性肾盂肾炎·······························38

（11）妊娠合并病毒性肝炎····································40

（12）妊娠合并急腹症·······································41

①妊娠合并急性阑尾炎····································41

②妊娠合并消化性溃疡急性穿孔·····························41

③妊娠合并胆囊炎及胆石症·································42

④妊娠合并肠梗阻······································42

⑤妊娠合并急性胰腺炎·····································42

⑥妊娠合并卵巢囊肿蒂扭转·································43

⑦妊娠期急腹症手术应注意的问题···························43

6、产科手术·············································44

（1）剖宫产···············································44

（2）会阴切开缝合术········································46

（3）产钳术··································47

（4）胎头吸引术………………………………………….

（5）外倒转术··············································50

（6）臀位助产术············································51

（7）臀位牵引术·····································51

（8）宫颈探查术············································52

（9）人工剥离胎盘术········································52

（10）清宫术···············································53

（11）子宫腔纱布条填塞术···································53

（12）引产术·············································53

7、分娩期并发症··········································56

（1）先兆子宫破裂···································56

（2）子宫破裂············································56

（3）产后出血（PPH）·····································57

（4）胎膜早破············································60

（5）脐带先露及脐带脱垂····································61

（6）胎儿宫内窘迫································61

（7）羊水栓塞········································62

8、产后疾病·········································63

（1）晚期产后出血······································63

（2）产褥感染·········································61

（3）产后尿储留·····································66

（4）乳胀与乳头毅裂·······································66

9、产科危重病人抢救（MICU）······························67

（1）心跳骤停、心肺复苏··································67

（2）产科抢救············································68

（3）呼吸衰竭抢救·········································69

（4）产科休克抢救········································69

（5）水、电解质平衡及酸碱平衡紊乱诊断与处理·················71

（6）急性子宫内翻症···································78

第二章妇科疾病········································80

1、外阴病变·······································80

（1）外阴痰痒症········································80

（2）硬化性萎缩性苔鲜····································80

（3）增生性营养障碍·······································81

（4）前庭大腺炎·································81

（5）外阴溃疡··········································81

（6）外阴创伤·······································82

2、女性生殖器炎症·······································82

（1）滴虫性阴道炎···································82

（2）霉菌性阴道炎·······································83

（3）老年性阴道炎··········································83

（4）非特异性阴道炎·······································83

（5）子宫颈炎·········································84

①急性子宫颈炎·······································84

②慢性子宫颈炎································84

（6）子宫内膜炎········································85

（7）盆腔炎···········································86

①急性盆腔炎············································86

②慢性盆腔炎及亚急性盆腔炎·······························86

3、早、中期妊娠疾病····································87

（1）流产··············································87

①先兆流产············································87

②难免流产·············································88

③不全流产···········································88

④完全流产············································88

⑤过期流产··········································88

⑥习惯性流产···········································89

（2）妊娠剧吐··········································89

（3）异位妊娠··········································89

4、妇科肿瘤············································90

（l）外阴癌·········································90

（2）子宫颈癌·············································91

（3）子宫肌瘤··········································93

（4）子宫内膜癌·········································94

（5）卵巢肿瘤············································95

（6）滋养细胞肿瘤········································96

②、侵蚀性葡萄胎和绒毛膜癌····························97

5、内分泌疾病·······································98

（1）功能性子宫出血病·····································98

①无排卵型功能性子宫出血···························99

②有排卵型功能性子宫出血·····················100

（2）经前期紧张综合症·······························100

（3）子宫内膜异位症······································101

（4）子宫腺肌病·····································101

6、损伤性疾病·········································102

（1）尿瘩···········································102

（2）直肠阴道痰·································102

（3）子宫脱垂········································103

（4）陈旧性会阴m度撕裂···································103

7、女性生殖器官畸形·································104

（1）处女膜闭锁································104

（2）先天性无阴道···································104

（3）阴道横隔···········································105

（4）阴道纵隔或斜隔·····································105

（5）子宫发育异常······························105

第三章生殖健康科及计划生育疾病························106

1、计划生育手术常规······················106

（1）宫内节育器放置常规...2

（2）宫内节育器取出常规...16

（3）输卵管结扎术常规...41

（4）负压吸宫术常规...59

（5）钳刮术常规...65

（6）米非司酮配伍前列腺素终止早期妊娠常规...72

（7）依沙吖啶羊膜腔内注射中期妊娠引产常规...82

（8）水囊引产常规...88

（9）经腹剖宫取胎术·································114

2、复杂计划生育并发症处理常规····························116

（1）终止妊娠并发症····································116

（2）腹式输卵管结扎术并发症·····························120

3、输卵管吻合术（再通术）······························122

4、清宫术········································123

5、宫注术·····································124

6、女性不孕症·········································125

7、高泌乳素血症及闭经泌乳综合征························127

8、多囊卵巢综合征··································129

9、闭经········································131

10、淋病·······································134

11、尖锐湿疵·····································135

第四章妇产科常用诊疗技术操作规程························137

1、内窥镜检查·······························137

（1）腹腔镜·········································137

①检查性腹腔镜···································137

②手术性腹腔镜····································138

（2）宫腔镜检查······························139

（3）阴道镜检查··································141

2、宫颈刮片细胞学检查·································142

3、宫颈活检·········································143

4、宫颈粘液检查·····································143

5、取内膜术····························144

6、诊断性刮宫·······································144

7、后弯隆穿刺术·······································145

8、子宫输卵管造影术···························146

9、宫颈息肉摘除术·······························147

10、激光治疗································148

第一章产科疾病

产前检查

一、就诊范围及复诊时间

1.初诊预约：

于孕三个月内开始立孕妇联系卡。

2.约定孕妇定期参加孕妇学校听课，学习孕期保健、临产分娩、母乳喂养及产后保健等知识。

3.预约复诊时间:

孕20周前检查2-3次，孕20-28周，每4周复查1次，孕28-36周每2周复查1次，孕36周开始每周复查1次，有异常情况随时来院检查，如:

身体不适，腹胀，腹痛，阴道流血、流水，头昏头痛，水肿，高血压等。

二、初诊内容

（一）病史采集

1一般情况:

姓名、年龄、职业、籍贯、家庭地址、丈夫姓名及工作单位。

2.现病史:

孕早期反应、自觉胎动时间、饮食、大小便情况、有否头昏、眼花、腰酸、阴道流血、孕期内服药物及病毒感染史、有否内科疾病及其治疗情况。

3月经史:

初潮年龄、月经周期情况、末次月经日期及推算预产期。

4婚产史:

结婚年龄，是否近亲结婚，有无早产、难产、死胎、死产史，既往分娩、有无产前、产后出血史，感染等病史，新生儿体重及健康情况，如系剖宫产需了解手术指征、手术方式、子宫切口位置、术前、术后有无感染史、及伤口愈合情况。

5.家族史:

有无高血压、精神病、内分泌及遗传病史等。

6过去史:

有无肝炎、肾炎、高血压等病史，有无手术及药物过敏史等。

（二）体检

1一般情况:

注意孕妇体态、步态、发育、营养状况、皮肤巩膜有无黄染、身高、体重、血压等。

2.全体情况:

包括头颅、五官、颈、胸、心肺、乳房发育大小、乳头有否凹陷、腹部、肝、脾、脊柱四胶等情况。

描绘妊娠图。

3产科检查及骨盆外测量:

包括产科腹部四步手法检查、宫底高度、胎位、胎先露及是否人盆、测量宫高、腹围、听胎心音、必要时作阴查，了解阴道有无炎症、畸形、肿瘤，取阴道分泌物查滴虫、霉茵、淋菌等，孕37周以后门诊不做阴查。

（三）化验检查

1.血常规、血型。

2尿常规、尿糖。

3孕妇年龄30岁以上需作宫颈刮片防癌检查（37周后不做）。

4.肝功能+HAA。

5血巨细胞病毒、风疹病毒、弓形体、淋病、梅毒、艾滋病等检查。

6.阴道分泌物常规检查。

（四）特殊检查

1.纠正贫血:

红细胞<3.0X10'2/L，血色素<100g/L予补血药物治疗。

血色素<80g/L应进一步查明贫血原因，积极治疗贫血。

2、产前筛查：

地贫、唐氏综合征、神经管缺陷。

3、糖耐量筛查。

三、复诊

1.测量体重、血压，如体重一周内增加超过500g，血压升高>4/2kpa或达17/12kpa时应作尿蛋白检查。

2.测量宫高、腹围，检查胎位，胎先露及先露衔接情况，听胎心音，数胎心率，估计胎儿大小，检查下肢有否浮肿，填写妊娠图，注意有无胎儿宫内生长迟缓或胎儿过大。

四、高危门诊

孕妇有以下情况，可到高危门诊随访和检查，进行系统监护，针对各种不同病因进行治疗