产科并发症英课件.ppt

《产科并发症英课件.ppt》由会员分享，可在线阅读，更多相关《产科并发症英课件.ppt（44页珍藏版）》请在三一办公上搜索。

1、LATER PREGNANCY COMPLICATIONS,产科并发症英,1,LATER PREGNANCY COMPLICATIONS产,Premature deliveryProlonged pregnancyPremature Rupture of Membranes( PROM),Content,产科并发症英,2,Premature deliveryContent产科并发症,PRETERM LABOR早 产,产科并发症英,3,PRETERM LABOR产科并发症英3,Preterm Labor: Labor occurs after 28 weeks but before 37 wee

2、ks (ie.196258days) gestation. Infants born during these phase are premature infants. The premature infants weight is between 1000 and 2499g. The prognosis of the premature infant is correlated with its gestational age, weight.,Definition:,产科并发症英,4,Preterm Labor: Definition:,Etiology:,1.Obstetric com

3、plications 产科并发症2.Medical complications 内科并发症3.Surgical complications 外科并发症4.Genital tract anomalies 生殖道畸形,产科并发症英,5,Etiology:1.Obstetric complicat,1.Obstetric complications: Severe hypertensive state or pregnancyAnatomic disorder of the placenta( abruptio placentae, placenta previa)Premature rupture

4、 of membranes Polyhydramnios or oligohydramniosMultiple pregnancyPrevious laceration（裂伤） of cervix or uterus,产科并发症英,6,1.Obstetric complications: 产科并,2.Medical complications:Pulmonary or systemic hypertensionRenal diseaseHeart diseaseInfection: genital tract infection, urinary tract infection, pyelon

5、ephritis肾盂肾炎, acute systemic infectionHeavy cigarette smokingAlcoholism or drug addictionSevere anemia,产科并发症英,7,2.Medical complications:产科并发症英,3.Surgical complications:Conization of cervix宫颈锥切术Previous incision in uterus or cervix ( cesarean delivery剖宫产术)4.Genital tract anomaliesBicornuate双角, subsep

6、tate纵隔, or unicormuate单角 uterusCongenital cervical incompetency先天性宫颈闭合不全,产科并发症英,8,3.Surgical complications:产科并发症,Clinical Finding & Diagnosis,1.Symptom and SignUterine contractionsmore than 2 in one-half hour;Vaginal bleeding-bloody mucous vaginal discharge or “bloody show”;Dilatation扩张 and effaceme

7、nt消退 of cervix-change in dilatation or effacement of at least 1cm or a cervix that is well effaced and dilatated (at least 2 cm);,产科并发症英,9,Clinical Finding & Diagnosis1.,2. Laboratory StudiesCompletely blood count with differentialCervix discharge cultures ：should be sent for gonorrhea淋病 and chlamyd

8、ia衣原体. Fetal fibronectin纤连蛋白（Ffn): negative test is effective at ruling out imminent delivery(within 2 weeks)； positive test （Ffn50ng/ml): result is sensitive at predicting preterm birth.分泌物,产科并发症英,10,2. Laboratory Studies产科并发症英10,3. Accessory examination:Ultrasound examination for fetal size, posit

9、ion, placenta location，and cervical length. Cervical length30nm: prognosticating premature delivery. Infundibulum漏斗 length of cervical internal os25% Cervical length or Amniocentesis to ascertain fetal lung maturity, the amnio fluid羊水 be tested for lecithin卵磷脂/ sphingomyelin鞘磷脂 (L/S) ratio,产科并发症英,11

10、,3. Accessory examination:产科并发症,rinciple: If the fetus is alive, with no PROM 胎膜早破, fetal distress , or the severe pregnancy complications，the uterine contraction should be inhibited to prolong the gestational age. If premature delivery is unavoidable, something must be done to elevate the survival

11、rate of the premature infant.,Treatment:,产科并发症英,12,principle: If the fet,1. Bed rest：2. Corticosteroids: to accelerate fetal lung maturity Betamethason 倍他米松: 12mg IM 1/24 hr 2 doses Dexamethasone地塞米松: 6 mg IM 1/12 hr 4 doses3. Antibiotics: no benefit in delaying preterm birth.4. Tocolysis：,产科并发症英,13

12、,1. Bed rest：产科并发症英13,4.Tocolysis Tocolytic therapy should be considered in the patient with cervical dilation less than 3 cm.(1) Beta-Mimetic Adrenergic Agents肾上腺受体激动剂 Ritodrine利托君， Terbutaline特布他林， salbutamol沙丁胺醇：(2) Magnesium sulfate硫酸镁: first line agent for tocolysis;(3) Calcium Channel Blockers

13、钙离子通道拮抗剂; nifedipine硝苯地平(4) Prostaglandin Synthetase Inhibitors前列腺素合成抑制剂 indomethacin吲哚美辛,产科并发症英,14,4.Tocolysis Tocolytic th,Some cases in which preterm labor should not be suppressed. Maternal factors: Fetal factors:Maternal factors:Severe hypertensive diseasePulmonary or cardiac diseaseAdvanced ce

14、rvical dilationMaternal hemorrhage,产科并发症英,15,Some cases in which,Fetal factors:Fetal death or lethal anomalyFetal distressIntrauterine infectionTherapy adversely affecting the fetusEstimated fetal weight2500gErythroblastosis fetalisSevere intrauterine growth retardation,产科并发症英,16,Fetal factors:产科并发症

15、英16,Manner of labor 1. Vaginal delivery: perineum section会阴切开术 2. Cesarean section: abnormal fetal position胎位异常 fetal distress胎儿窘迫 maternal hemorrhage孕妇出血 severe maternal complications孕妇严重的并发症,产科并发症英,17,Manner of labor产科并发症英17,Case File,A healthy 20-year-old pregnant woman, G1P0 at 29 weeks gestatio

16、n present to the labor and delivery area complaining of intermitten abdominal pain. She denies leakage of fluid or bleeding per vagina. Her antenatal history has been unremarkable. She has been eating and drinking normally. On examination, the fetal heart rate tracing reveals a baseline heart rate o

17、f 120bpm and reactive pattern. Uterine contraction are occuring every 3 to 5 min. On pelvic examination, her cervix is 1 cm dilated, 90% effaced, and fetal vertex is presenting at -1 station.,产科并发症英,18,Case File A healthy 20-year-ol,What is the most likely diagnosis? Preterm labor.What is your next

18、step in management? Tocolysis, try to identify a cause of the preterm labor, antenatal steroids, and antibiotics.,Questions,产科并发症英,19,What is the most likely diagn,PROLONGED PREGNANCY(POSTTERM PREGNANCY),产科并发症英,20,PROLONGED PREGNANCY(POSTTERM,General consideration:,Definition: Prolonged pregnancy is

19、 defined as pregnancy that has reached 42 weeks of completed gestation from the first day of the LMP or 40 weeks gestation from the time of conception.,产科并发症英,21,General consideration:Definiti,The maternal risk: Related to extraordinary fetal size:Dysfunctional labor功能障碍性分娩Arrested progress of labor

20、 产程停止 Fetopelvic disproportion胎盆不称 Cesarean section 剖宫产 Labor trauma 分娩损伤,产科并发症英,22,The maternal risk: 产科并发症英22,Effect to fetus: Impaired nutritional supply ( weight loss, reduced subcutaneous tissue, scaling脱皮, parchmentlike skin羊皮纸样皮肤)-dysmaturity 成熟障碍 Birth injury ( shoulder dystocia肩难产) Oligohyd

21、ramnios羊水过少 Fetal distress胎儿窘迫Meconiurn aspiration syndroame （MAS)胎粪吸入综合征Asphyxia neonatorum新生儿窒息,产科并发症英,23,Effect to fetus:产科并发症英23,ETIOLOGY,Prolonged pregnancy may relate to:Dysfunction of estrogen/progesteron (E/P) ratio雌孕激素比例失调：prostaglandin前列腺素, estrogen雌激素 progestin孕激素cephalopelvic disproporti

22、on头盆不称（cpd): Fetal deformity胎儿畸形;Genetic factors遗传因素:placenta sulfatase deficiency胎盘硫酸酯酶,产科并发症英,24,ETIOLOGYProlonged pregnancy ma,PATHOLOGY,Placenta: normal or hypofunction功能减退 Amniotic fluid: Oligohydramnios羊水过少Meconium dye of amniotic fluid羊水粪染Fetus:Fetal macrosomia巨大胎儿Fetal dysmaturity胎儿成熟障碍Small

23、-for-date infant小样儿,产科并发症英,25,PATHOLOGYPlacenta: normal or h,Diagnosis:,1. Confirmation of gestational age: by referring to records of :Mecial history: LMP, the exact time of conception, ovulate time, et al;Clinical expression: early pregnancy reaction, quickening time, gynecological examination in

24、first trimester, et al; Laboratory tests: ultrasound: examination, and clinical parameters of early pregnancy ( e.g, hCG ),产科并发症英,26,Diagnosis: 1. Confirmation of,2. Judgment of the placental function:Fetal movement count胎动计数:Fetal electrical monitor胎儿电子监护:Ultrasound examination超声检查:Urine estrogen/c

25、reatinine ratio雌激素和肌酐比值 :Amnioscopy羊膜镜检查:,产科并发症英,27,2. Judgment of the placental f,Treatment:,Indication of terminal pregnancy:Cervical matureFetal weigth4000g, or non reaction pattern of NST, or CST positive (doubtful)Urine estrogen/creatinine ratio decreasedFetal movement OligohydramniosWith eclam

26、psia of pre-eclampsia,产科并发症英,28,Treatment: Indication of termi,1. Induced labor: Cervix is mature, bishop score7 When cervix is mature: 人工破膜Oxytocin, Prasterone普拉睾酮Prostaglandin前列腺素： propess普贝生(Dinoprostone Suppositories地诺前列酮栓）,产科并发症英,29,1. Induced labor: 产科并发症英29,3. Cesarean section:Failure of indu

27、ced labor;Arrested progress of labor;Fetal distress;Disposition;Large fetus;Amniotic fluid is abnormal;Pregnancy complications;Fetal compromise : breech presentation, et al.,产科并发症英,30,3. Cesarean section:产科并发症英30,Premature Rupture of Membranes( PROM),产科并发症英,31,Premature Rupture of Membranes,DEFINITI

28、ON,The fetal membrane rupture happens before labor. Premature rupture of membrane can cause preterm labor, prolapse of umbilical cord, and maternal and fetal infection. The less the gestational age, the worse the prognosis of the perinatal infant.,产科并发症英,32,DEFINITIONThe fetal membrane r,Essentials

29、of Diagnosis,1. History of a gush of fluid from the vagina or watery vaginal discharge;2. Demonstration of amniotic fluid leakage from the cervix.,产科并发症英,33,Essentials of Diagnosis1. Hist,ETIOLOGY,Genital tract pathogenic microorganism upgoing infection:Amniotic cavity pressure increase:Pressure on

30、fetal membrane is unbalanced;Nutritional factor;Cervical incompetence;Cytokine:,产科并发症英,34,ETIOLOGYGenital tract pathogen,Pathology & Pathophysiology,Preterm laborProlapse of the umbilical cordPlacenta abruptionIntrauterine infectionChorioamnionitis,产科并发症英,35,Pathology & PathophysiologyPre,DIAGNOSIS,

31、1. SymptomSudden gush of fluid or continued leakageThe color and consistency of the fluid and the presence of Vernix caseosa胎脂or meconium胎粪, reduce size of the uterus, and increased prominence of the fetus to palpation.,产科并发症英,36,DIAGNOSIS1. Symptom产科并发症英36,2. Sterile speculum examinationPooling: th

32、e collection of amniotic fluid in the posterior fornix ;Nitrazine test: the nitrazine paper turns blue, demonstrating an alkaline PH (7.0-7.25);Ferning : Fluid from the posterior fornix is placed on a slide and allowed to air-dry. Amniotic fluid will form a fernlike pattern of crystallization;Be car

33、e of false negative result: vaginal infections, presence of blood or semen,产科并发症英,37,2. Sterile speculum examinatio,3. Physical examination:To search for other signs for infection.4. Laboratory studies:Complete blood count with differentialUltrasound examination for fetal size and amniotic fluid ind

34、exAmniocentesis to determine fetal lung maturity and the presence of infection,产科并发症英,38,3. Physical examination:产科并发症,5. ChorioamniotisThe most reliable signs of infection include:Fever: the temperature should be checked every 4 hoursMaternal leukocytosis: daily leukocyte count and differential. An

35、 increase in the white blood cell count or neutrophil count may indicate the presence of intra-amniotice infectionUterine tenderness: check every 4 hoursTachycardia: either maternal pulse 100bpm or fetal heart 160 bpm is suspicious.,产科并发症英,39,5. Chorioamniotis产科并发症英39,Influence on Mother and Fetus,I

36、nfluence on mother:Infection;Placenta abruptionInfluence on fetus:Premature deliveryrespiratory distress syndrome of newborn新生儿呼吸窘迫综合症Chorioamnionitis绒毛膜羊膜炎aspiration pneumonitis of newborn新生儿吸入性肺炎，septicemia败血症prolapse of cord脐带脱垂fetal distress,产科并发症英,40,Influence on Mother and FetusI,Treatment,1.E

37、xpectant management: is appropriate for those whose gestational age between 28 and 35 weeks, without chorioamnionitisGeneral management: bed rest, hydration, clean, patients temperature, heart rate, contraction, vaginal leakage, blood leukocyte count, et al.Antibiotic:Tocolysis:Corticosteroids:,产科并发

38、症英,41,Treatment1.Expectant managemen,2. Chorioamnionitis (1) delivery: If chorioamnionitis is present in the patient with PROM, the patient should be actively delivered regardless of gestational age. (2) Broad-spectrum antibiotics,产科并发症英,42,2. Chorioamnionitis产科并发症英42,3. Term pregnancy without chorioamnionitis: (1) Expectant management: Waiting for patient to go into labor spontaneously; (2) Active management: Induction of labor with an agent such as oxytocin;,产科并发症英,43,3. Term pregnancy without chor,Thank you!,产科并发症英,44,Thank you!产科并发症英44,