《前置胎盘英文》课件

PlacetalPreviaPlacetalPrevia1Case1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase1Case1.30G3P2at32weeks2Whatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?Whatismostlikelydiagnosis?3《前置胎盘英文》课件4《前置胎盘英文》课件5Whatarethemostcommoncausesof

AntepartumHemorrhage?Whatarethemostcommoncause6COMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSES

Uterinerupture

Fetal(chorionic)vesselrupture

Cervicalorvaginallacerations

Cervicalorvaginallesions,includingcancer

Congenitalbleedingdisorder

Unknown(byexclusionoftheabove)COMMONCAUSESPlacentaPreviaUN7PlacentalPreviaPlacentalPrevia8UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectivesUnderstandthatplacentaprev9Definedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；

International：0.5%~0.9%。PlacentalPreviaDefinedastheinferioredgeo10“theplacentaoverlyingtheinternalosofthecervix”“theplacentaoverlyingthei11ClassificationClassification12ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentapreviaClassificationComplete(central13WhataretheriskfactorsforplacentalPrevia?Question

Whataretheriskfactorsfor14ETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGYETIOLOGYIncreasedmaternalage15ManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentationManifestationClinicalPresenta16Manifestation

Theclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.ManifestationTheclass17TotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalMarginalplacentaprevia

Late(37-40WKSorinlabor)LessbleedingTotalplacentapreviaPartialp18

symptom

Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.

Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.symptomSeverebloodl19Complicationofmother

andfetus

BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredeliveryComplicationofmother

20HowtodiagnosetheplacentalPrevia?Question

Howtodiagnosetheplacental21PatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”PatientHistory–PlacentaPre22PhysicalExam–PlacentaPrevia

TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknownPhysicalExam–PlacentaPrevi23AuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI

PosteriorpreviaHighcostLimitedavailabilityAuxiliaryexaminationB-ultr24《前置胎盘英文》课件25Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowallLaboratory–PlacentaPreviaHe26Differentiation

diagnosisPlacentalabruption

vesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma

DifferentiationdiagnosisPlace27《前置胎盘英文》课件28Management

Expectantdelivery

aimat

achievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.ManagementExpectantdelivery29Management

expectanttreatment

Indication:

FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g

Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfectionManagementexpectanttreatmen30TerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement

TerminationofpregnancyManage31《前置胎盘英文》课件32Vaginaldelivery

Marginalplacentaprevia

VaginalbleedingislimitedManagement

VaginaldeliveryManagement33AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement

Management34PlacentaPrevia

ManagementSeverebleedingCaesareansectionModeratebleedingGestation>34<34ResuscitateSteroidsUnstableStableResuscitateMildbleedingGestation<36Conservativecare>36Management

PlacentaPrevia

ManagementSeve35Managementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentationManagementofplacentaprevia?36UltrasoundexaminationPlacenta

previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestationUltrasoundexaminationPlacent37Eachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1BEachofthefollowingisaris38Eachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2BEachofthefollowingisaty39A33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingisthebestmanagementforthispatient?A)Inductionoflabor;B)Tocolysisoflabor;C)Cesareandelivery;D)ExpectantmanagementE)IntrauterinetransfusionExercise3CA33-year-oldwomanat37wee40A22-year-oldG1P0womanat34week’sgestationpresentswithmoderatevaginalbleedingandnouterinecontractions.Whichofthefollowingsequenceofexaminationsismostappropriate?A)Speculumexamination,ultrasoundexamination,digitalexamination;B)Ultrasoundexamination,digitalexamination,speculumexamination;C)Digitalexamination,ultrasoundexamination,speculumexamination;D)Ultrasoundexamination,speculumexamination,digitalexamination;Exercise4DA22-year-oldG1P0womanat3441An18-yeas-oldwomanisnotedtohaveamarginalplacentapreviaonanultrasoundexaminationat22week’sgestation.Whichofthefollowingisthemostappropriatemanagement?A)Schedulecesareandeliveryat39weeks;B)Scheduleanamniocentesisat36weeksanddeliverbycesareanifthefetallungsaremature;C)ScheduleanMRIexaminationat35weekstoassessforpossiblepercretainvolvingthebladder;D)Reassessplacentalpositionat32weeksE)RecommendterminationofpregnancyExercise5DAn18-yeas-oldwomanisnoted42UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectivesUnderstandthatplacentaprev43《前置胎盘英文》课件44PlacetalPreviaPlacetalPrevia45Case1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase1Case1.30G3P2at32weeks46Whatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?Whatismostlikelydiagnosis?47《前置胎盘英文》课件48《前置胎盘英文》课件49Whatarethemostcommoncausesof

AntepartumHemorrhage?Whatarethemostcommoncause50COMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSES

Uterinerupture

Fetal(chorionic)vesselrupture

Cervicalorvaginallacerations

Cervicalorvaginallesions,includingcancer

Congenitalbleedingdisorder

Unknown(byexclusionoftheabove)COMMONCAUSESPlacentaPreviaUN51PlacentalPreviaPlacentalPrevia52UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectivesUnderstandthatplacentaprev53Definedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；

International：0.5%~0.9%。PlacentalPreviaDefinedastheinferioredgeo54“theplacentaoverlyingtheinternalosofthecervix”“theplacentaoverlyingthei55ClassificationClassification56ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentapreviaClassificationComplete(central57WhataretheriskfactorsforplacentalPrevia?Question

Whataretheriskfactorsfor58ETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGYETIOLOGYIncreasedmaternalage59ManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentationManifestationClinicalPresenta60Manifestation

Theclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.ManifestationTheclass61TotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalMarginalplacentaprevia

Late(37-40WKSorinlabor)LessbleedingTotalplacentapreviaPartialp62

symptom

Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.

Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.symptomSeverebloodl63Complicationofmother

andfetus

BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredeliveryComplicationofmother

64HowtodiagnosetheplacentalPrevia?Question

Howtodiagnosetheplacental65PatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”PatientHistory–PlacentaPre66PhysicalExam–PlacentaPrevia

TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknownPhysicalExam–PlacentaPrevi67AuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI

PosteriorpreviaHighcostLimitedavailabilityAuxiliaryexaminationB-ultr68《前置胎盘英文》课件69Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowallLaboratory–PlacentaPreviaHe70Differentiation

diagnosisPlacentalabruption

vesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma

DifferentiationdiagnosisPlace71《前置胎盘英文》课件72Management

Expectantdelivery

aimat

achievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.ManagementExpectantdelivery73Management

expectanttreatment

Indication:

FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g

Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfectionManagementexpectanttreatmen74TerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement

TerminationofpregnancyManage75《前置胎盘英文》课件76Vaginaldelivery

Marginalplacentaprevia

VaginalbleedingislimitedManagement

VaginaldeliveryManagement77AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement

Management78PlacentaPrevia

ManagementSeverebleedingCaesareansectionModeratebleedingGestation>34<34ResuscitateSteroidsUnstableStableResuscitateMildbleedingGestation<36Conservativecare>36Management

PlacentaPrevia

ManagementSeve79Managementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentationManagementofplacentaprevia?80UltrasoundexaminationPlacenta

previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestationUltrasoundexaminationPlacent81Eachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1BEachofthefollowingisaris82Eachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2BEachofthefollowingisaty83A33-year-oldwomanat37week