Chapter 12 Antepartum Hemorrhage Placenta Previa Definition After

Chapter 12 Antepartum. Hemorrhage

一. Placenta Previa Definition ： After 28 pregnant weeks placental implantation over the cervical os or in the lower uterine segment.

Etiology ： The cause of placenta previa remains unclear. but possible etiologic factors. as 1、poorly vascularized endometrium. 2、large placenta. 3、Abnormal placenta 4、placenta implanted in the lower uterine segment

Classification 1、cmplete placenta previa. 2、partial placenta previa 3、marginal placenta previa

Clinical manifeslation 1、symptoms： sudden painless vaginal bleeding , bleeding results from detachment of placental tissue as the lower uterine lengthens and the subsequent Inability

of the lower segment to contract , vessels contrict to stop the bleeding 。 2、signs: uterus usually is soft and nontender , the fetal presenting part is not into the pelvic inlet 。

Diagnosis 1、History, After 28 pregnant weeks , sudden painless intermittent vaginal bleeding. 2、Sings , anaemia or shock. 3、Vaginal examination preparations for transfusion opreration delivery , if the diagnosis of placenta previa

is sufficient or profuse vaginal bleeding , the vaginal examination should be omitted. 4、ultrsound examination. 5、examination of the placental and fetalmembrane After delivery.

Differential Diagnosis Complications 1、postpartum bleeding 2、placenta accreta 3、infection 4、amniotic fluid embolism

5、prematurity and perinatal fetal death treatment 1、Expectant Therapy 2、vaginal delivery cesarean section

二、Placenta Abruption Definition：the premature separation of a normally implanted placenta from the uterus After 20 pregant weeks 。

Etiology 1、Local vascular injury results in vascular rupture into the decidua basalis, bleeding , and hematoma formation。 2、Mechanical factors 3、abrupt uterine contract 4、uterine venous pressure rise abruptly

Classification 1、revealed 2、concealed 3、mixed Patho physiology blood can be trapped between plancenta and uterine wall ， then infiltrates the uteine wall uteroplacental apoplexy。

Clinical manifestation 1、characterized by vaginal bleeding uterine irritability maternal blood pressure serum fibrinogen level and fetal heart rate are all normal。 2、characterized by concealed or mixed bleeding painful，tetanic uterine contractions ， uterine tenderness ，or back pain，

Diagnosis and differential Diagnosis History：symptoms signs ultra sound complications 1、Disseminated intravascular coagulopathy 2、postpartum hemorrhage 3、Acute renal failure 4、fetal death in uterus

Treatment 1、Antishock measures 2、vaginal delivery 3、cesarean section Treatment for complications 1、postpartum hemorrhage ： stimulate utrine contractions ， hysterectomy

2、Disorder of coagulation A、Anticoagulation Administration of Heparin. B、Fresh whole blood Fibrimogen platelets. C、Antifibrinolysis D、failure of renal function

前置胎盘 （placenta praevia）

胎盘早剥 （placental abruption）