产科并发症专题知识讲座培训课件

1、产科并发症专题知识讲座产科并发症专题知识讲座Premature deliveryProlonged pregnancyPremature Rupture of Membranes( PROM)Content产科并发症专题知识讲座2Premature deliveryContent产科并发症PRETERM LABOR早 产产科并发症专题知识讲座3PRETERM LABOR产科并发症专题知识讲座3 Preterm Labor: Labor occurs after 28 weeks but before 37 weeks (ie.196258days) gestation. Infants bor

2、n 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: 产科并发症专题知识讲座4 Preterm Labor: Definition:Premature infantMature infant产科并发症专题知识讲座5Premature infantMature

3、infant产Etiology:1.Obstetric complications 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专题知识讲座6Etiology:1.Obstetric complicat1.Obstetric complications: Severe hypertensive state or pregnancyAnatomic disorder of the placenta( abruptio placentae, p

4、lacenta previa)Premature rupture of membranes Polyhydramnios or oligohydramniosMultiple pregnancyPrevious laceration（裂伤） of cervix or uterus产科并发症专题知识讲座71.Obstetric complications: 产科并2.Medical complications:Pulmonary or systemic hypertensionRenal diseaseHeart diseaseInfection: genital tract infection

5、, urinary tract infection, pyelonephritis肾盂肾炎, acute systemic infectionHeavy cigarette smokingAlcoholism or drug addictionSevere anemia产科并发症专题知识讲座82.Medical complications:产科并发症专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 t

6、ract anomaliesBicornuate双角, subseptate纵隔, or unicormuate单角 uterusCongenital cervical incompetency先天性宫颈闭合不全产科并发症专题知识讲座93.Surgical complications:产科并发症Clinical Finding & Diagnosis1.Symptom and SignUterine contractionsmore than 2 in one-half hour;Vaginal bleeding-bloody mucous vaginal discharge or “bloo

7、dy show”;Dilatation扩张 and effacement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);产科并发症专题知识讲座10Clinical Finding & Diagnosis1.2. Laboratory StudiesCompletely blood count with differentialCervix discharge cultures ：should

8、 be sent for gonorrhea淋病 and chlamydia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.分泌物产科并发症专题知识讲座112. Laboratory Studies产科并发症专题知识3. Accessory examination:Ultras

9、ound examination for fetal size, position, 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/

10、sphingomyelin鞘磷脂 (L/S) ratio产科并发症专题知识讲座123. Accessory examination:产科并发症 principle: 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, someth

11、ing must be done to elevate the survival rate of the premature infant.Treatment:产科并发症专题知识讲座13 principle: If the fet1. 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 dela

12、ying preterm birth.4. Tocolysis：产科并发症专题知识讲座141. Bed rest：产科并发症专题知识讲座14 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

13、 agent for tocolysis;(3) Calcium Channel Blockers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专题知识讲座15 4.Tocolysis Tocolytic th Some cases in which preterm labor should not be suppressed. Maternal factors: Fetal factors:Maternal factors:Severe hyperte

14、nsive diseasePulmonary or cardiac diseaseAdvanced cervical dilationMaternal hemorrhage产科并发症专题知识讲座16 Some cases in which Fetal factors:Fetal death or lethal anomalyFetal distressIntrauterine infectionTherapy adversely affecting the fetusEstimated fetal weight2500gErythroblastosis fetalisSevere intrau

15、terine growth retardation产科并发症专题知识讲座17Fetal factors:产科并发症专题知识讲座17Manner 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 产科并发症专题知识讲座18Manner of labor产科并发症专题知识讲座18Case

16、File A healthy 20-year-old pregnant woman, G1P0 at 29 weeks gestation 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 exami

17、nation, the fetal heart rate tracing reveals a baseline heart rate of 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.产科并发症专题知识讲座19Case File A healthy 20-year-

18、ol What is the most likely diagnosis? Preterm labor.What is your next step in management? Tocolysis, try to identify a cause of the preterm labor, antenatal steroids, and antibiotics.Questions产科并发症专题知识讲座20 What is the most likely diagnPROLONGED PREGNANCY(POSTTERM PREGNANCY)产科并发症专题知识讲座21PROLONGED PRE

19、GNANCY(POSTTERM General consideration:Definition: Prolonged pregnancy is 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. 产科并发症专题知识讲座22General consideration:Definiti The maternal risk: Related to ex

20、traordinary fetal size:Dysfunctional labor功能障碍性分娩Arrested progress of labor 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专题知识讲座23 The maternal risk: 产科并发症专题知识讲Effect to fetus: Impaired nutritional supply ( weight loss, reduced subcutaneous tissue, scaling脱皮, parchment

21、like skin羊皮纸样皮肤)-dysmaturity 成熟障碍 Birth injury ( shoulder dystocia肩难产) Oligohydramnios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专题知识讲座24Effect to fetus:产科并发症专题知识讲座24ETIOLOGYProlonged pregnancy may relate to:Dysfunction of estrogen/progesteron (E/P

22、) ratio雌孕激素比例失调：prostaglandin前列腺素, estrogen雌激素 progestin孕激素cephalopelvic disproportion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专题知识讲座25ETIOLOGYProlonged pregnancy maPATHOLOGYPlacenta: normal or hypofunction功能减退 Amniotic fluid: Oligohydramnios羊水过少Meco

23、nium dye of amniotic fluid羊水粪染Fetus:Fetal macrosomia巨大胎儿Fetal dysmaturity胎儿成熟障碍Small-for-date infant小样儿产科并发症专题知识讲座26PATHOLOGYPlacenta: normal or hDiagnosis: 1. Confirmation of gestational age: by referring to records of :Mecial history: LMP, the exact time of conception, ovulate time, et al;Clinical

24、 expression: early pregnancy reaction, quickening time, gynecological examination in first trimester, et al; Laboratory tests: ultrasound: examination, and clinical parameters of early pregnancy ( e.g, hCG )产科并发症专题知识讲座27Diagnosis: 1. Confirmation of 2. Judgment of the placental function:Fetal moveme

25、nt count胎动计数:Fetal electrical monitor胎儿电子监护:Ultrasound examination超声检查:Urine estrogen/creatinine ratio雌激素和肌酐比值 :Amnioscopy羊膜镜检查:产科并发症专题知识讲座282. Judgment of the placental fTreatment: Indication of terminal pregnancy:Cervical matureFetal weigth4000g, or non reaction pattern of NST, or CST positive (do

26、ubtful)Urine estrogen/creatinine ratio decreasedFetal movement OligohydramniosWith eclampsia of pre-eclampsia产科并发症专题知识讲座29Treatment: Indication of termi1. 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 Supp

27、ositories地诺前列酮栓）产科并发症专题知识讲座301. Induced labor: 产科并发症专题知识讲座产科并发症专题知识讲座培训课件Premature Rupture of Membranes( PROM)产科并发症专题知识讲座32Premature Rupture of MembranesDEFINITIONThe fetal membrane rupture happens before labor. Premature rupture of membrane can cause preterm labor, prolapse of umbilical cord, and m

28、aternal and fetal infection. The less the gestational age, the worse the prognosis of the perinatal infant. 产科并发症专题知识讲座33DEFINITIONThe fetal membrane rEssentials of Diagnosis1. History of a gush of fluid from the vagina or watery vaginal discharge;2. Demonstration of amniotic fluid leakage from the

29、cervix.产科并发症专题知识讲座34Essentials of Diagnosis1. HistETIOLOGYGenital tract pathogenic microorganism upgoing infection:Amniotic cavity pressure increase:Pressure on fetal membrane is unbalanced;Nutritional factor;Cervical incompetence;Cytokine: 产科并发症专题知识讲座35ETIOLOGYGenital tract pathogenPathology & Path

30、ophysiologyPreterm laborProlapse of the umbilical cordPlacenta abruptionIntrauterine infectionChorioamnionitis产科并发症专题知识讲座36Pathology & PathophysiologyPreDIAGNOSIS1. SymptomSudden gush of fluid or continued leakageThe color and consistency of the fluid and the presence of Vernix caseosa胎脂or meconium胎

31、粪, reduce size of the uterus, and increased prominence of the fetus to palpation.产科并发症专题知识讲座37DIAGNOSIS1. Symptom产科并发症专题知识讲座2. Sterile speculum examinationPooling: the collection of amniotic fluid in the posterior fornix ;Nitrazine test: the nitrazine paper turns blue, demonstrating an alkaline PH (

32、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 care of false negative result: vaginal infections, presence of blood or semen产科并发症专题知识讲座382. Sterile speculum examinatio3. Physical exami

33、nation:To search for other signs for infection.4. Laboratory studies:Complete blood count with differentialUltrasound examination for fetal size and amniotic fluid indexAmniocentesis to determine fetal lung maturity and the presence of infection产科并发症专题知识讲座393. Physical examination:产科并发症5. Chorioamni

34、otisThe most reliable signs of infection include:Fever: the temperature should be checked every 4 hoursMaternal leukocytosis: daily leukocyte count and differential. An 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.产科并发症专题知识讲座405. Chorioamniotis产科并发症专题知识讲座4Influence on Mother and FetusInfluen