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PlacetalPreviaLongXiaoyu龙晓宇XuanWuHospital宣武医院1.PlacetalPreviaLongXiaoyuCase1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase12.Case1.30G3P2at32weeksWhatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?3.Whatismostlikelydiagnosis?.Whatarethemostcommoncausesof

AntepartumHemorrhage?6.WhatarethemostcommoncauseCOMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselrupture

CervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorder

Unknown(byexclusionoftheabove)7.COMMONCAUSESPlacentaPreviaUNPlacentalPrevia8.PlacentalPrevia8.UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives9.UnderstandthatplacentaprevDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；

International：0.5%~0.9%。PlacentalPrevia10.Definedastheinferioredgeo“theplacentaoverlyingtheinternalosofthecervix”11.“theplacentaoverlyingtheiClassification12.Classification12.ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentaprevia13.ClassificationComplete(centralWhataretheriskfactorsforplacentalPrevia?Question

14.WhataretheriskfactorsforETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGY15.ETIOLOGYIncreasedmaternalageManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentation16.ManifestationClinicalPresentaManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.17.ManifestationTheclassTotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalMarginalplacentaprevia

Late(37-40WKSorinlabor)Lessbleeding18.TotalplacentapreviaPartialp

symptom

Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.

Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.19.symptomSeverebloodlComplicationofmother

andfetus

BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredelivery20.Complicationofmother

HowtodiagnosetheplacentalPrevia?Question

21.HowtodiagnosetheplacentalPatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”22.PatientHistory–PlacentaPrePhysicalExam–PlacentaPrevia

TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknown23.PhysicalExam–PlacentaPreviAuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI

PosteriorpreviaHighcostLimitedavailability24.AuxiliaryexaminationB-ultr25.25.Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowall26.Laboratory–PlacentaPreviaHeDifferentiation

diagnosisPlacentalabruptionvesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma

27.DifferentiationdiagnosisPlace28.28.Management

Expectantdelivery

aimatachievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.29.ManagementExpectantdelivery2Management

expectanttreatment

Indication:

FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g

Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfection30.ManagementexpectanttreatmenTerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement

31.TerminationofpregnancyManage32.32.Vaginaldelivery

Marginalplacentaprevia

VaginalbleedingislimitedManagement

33.VaginaldeliveryManagement33.AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement

34.Management34.PlacentaPrevia

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

35.PlacentaPrevia

ManagementSeveManagementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentation36.Managementofplacentaprevia?UltrasoundexaminationPlacenta

previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestation37.UltrasoundexaminationPlacentEachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1B38.EachofthefollowingisarisEachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2B39.EachofthefollowingisatyA33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingisthebestmanagementforthispatient?A)Inductionoflabor;B)Tocolysisoflabor;C)Cesareandelivery;D)ExpectantmanagementE)IntrauterinetransfusionExercise3C40.A33-year-oldwomanat37weeA22-year-oldG1P0womanat34week’sgestationpresentswithmoderatevaginalbleedingandnouterinecontractions.Whichofthefollowingsequenceofexaminationsismostappropriate?A)Speculumexamination,ultrasoundexamination,digitalexamination;B)Ultrasoundexamination,digitalexamination,speculumexamination;C)Digitalexamination,ultrasoundexamination,speculumexamination;D)Ultrasoundexamination,speculumexamination,digitalexamination;Exercise4D41.A22-year-oldG1P0womanat34An18-yeas-oldwomanisnotedtohaveamarginalplacentapreviaonanultrasoundexaminationat22week’sgestation.Whichofthefollowingisthemostappropriatemanagement?A)Schedulecesareandeliveryat39weeks;B)Scheduleanamniocentesisat36weeksanddeliverbycesareanifthefetallungsaremature;C)ScheduleanMRIexaminationat35weekstoassessforpossiblepercretainvolvingthebladder;D)Reassessplacentalpositionat32weeksE)RecommendterminationofpregnancyExercise5D42.An18-yeas-oldwomanisnotedUnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives43.Understandthatplacentaprev44.44.后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料仅供参考，实际情况实际分析45.后面内容直接删除就行45.感谢您的观看和下载Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield46.感谢您的观看和下载TheusercandemonstrPlacetalPreviaLongXiaoyu龙晓宇XuanWuHospital宣武医院47.PlacetalPreviaLongXiaoyuCase1.30G3P2at32weeks’gestation,painlessvaginalbleeding.Fourweeksago,postcoitalvaginalspotting2.BP:110/70mmHg,abdomenissoftuterusnontender,FHR:140-150bpmCase148.Case1.30G3P2at32weeksWhatismostlikelydiagnosis?Whatisyournextstep?Long-termmanagementofthispatient?49.Whatismostlikelydiagnosis?.Whatarethemostcommoncausesof

AntepartumHemorrhage?52.WhatarethemostcommoncauseCOMMONCAUSESPlacentaPreviaPlacentalAbruptionPretermlaborUNCOMMONCAUSESUterineruptureFetal(chorionic)vesselrupture

CervicalorvaginallacerationsCervicalorvaginallesions,includingcancerCongenitalbleedingdisorder

Unknown(byexclusionoftheabove)53.COMMONCAUSESPlacentaPreviaUNPlacentalPrevia54.PlacentalPrevia8.UnderstandthatplacentapreviaandplacentalabruptionaremajorcausesofantepartumhemorrhageKnowthepainlessvaginalbleedingisconsistentwithplacentapreviaUnderstandthattheultrasoundexaminationisagoodmethodforassessingplacentallocationObjectives55.UnderstandthatplacentaprevDefinedastheinferioredgeofplacentaloadattheloweruterinesegment,orevenreachtheinternalcervicalosafter28weeksgestation.Incidencerate:Internal：0.24%~1.57%；

International：0.5%~0.9%。PlacentalPrevia56.Definedastheinferioredgeo“theplacentaoverlyingtheinternalosofthecervix”57.“theplacentaoverlyingtheiClassification58.Classification12.ClassificationComplete(central)placentapreviaPartialplacentapreviaMarginalplacentapreviaLow-lyingplacentaprevia59.ClassificationComplete(centralWhataretheriskfactorsforplacentalPrevia?Question

60.WhataretheriskfactorsforETIOLOGYIncreasedmaternalageUterinefactors:PreviousCSInstrumentationoftheuterinecavity(DandCformiscarriagesorInducedAbortions)Placentalfactors:MultiparityMultiplegestationPriorplacentapreviaETIOLOGY61.ETIOLOGYIncreasedmaternalageManifestationItcharacteristicallypresentswithunprovokedandrepeatedpainlessvaginalbleeding.ClinicalPresentation62.ManifestationClinicalPresentaManifestationTheclassificationofpreviaplacentasometimesdeterminestheoccurrenceperiodandthevolumeoflosingblood.63.ManifestationTheclassTotalplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalBleedingtimeandvolumeCentralplacentapreviaEarly(20-28wks)LargeamountSeveraltimesPartialplacentaprevia

BetweentotalandmarginalMarginalplacentaprevia

Late(37-40WKSorinlabor)Lessbleeding64.TotalplacentapreviaPartialp

symptom

Severebloodlosingleadstoseveralshocksigns,suchaspaleness,weakandquickpulseandhypotension.

Malpresentationmaybeexists,andfloatingpresentationcouldbefoundduringlategestationalweeks.65.symptomSeverebloodlComplicationofmother

andfetus

BleedingatorpostpartumImplantationofplacentaAnemiaandpuerperalinfectionPrematuredelivery66.Complicationofmother

HowtodiagnosetheplacentalPrevia?Question

67.HowtodiagnosetheplacentalPatientHistory–PlacentaPreviaPainlessbleeding2ndor3rdtrimester,orattermOftenfollowingintercourseMayhavepretermcontractions“Sentinelbleed”68.PatientHistory–PlacentaPrePhysicalExam–PlacentaPrevia

TheuterusisusuallysoftandrelaxedAnomalyoffetalconditionFetusisusuallyaliveandwellPervaginaexaminationNOdigitalvaginalexamunlessplacentallocationknown69.PhysicalExam–PlacentaPreviAuxiliaryexaminationB-ultrasoundexaminationUltrasoundistheeasiest,mostreliablewaytodiagnose(95-98+%accuracy)Falsepositive-ultrasoundwithdistendedbladderTransvaginalortransperinealoftensuperiortotransabdominalmethodsMRI

PosteriorpreviaHighcostLimitedavailability70.AuxiliaryexaminationB-ultr71.25.Laboratory–PlacentaPreviaHematocritorcompletebloodcountBloodtypeandRhCoagulationtestsWhilewaiting–serumclottubetapedtowall72.Laboratory–PlacentaPreviaHeDifferentiation

diagnosisPlacentalabruptionvesselPreviaCervicalpolypusCervicalerosionCervicalcarcinoma

73.DifferentiationdiagnosisPlace74.28.Management

Expectantdelivery

aimatachievingamixmumfetalmaturitypossiblewhileminimizingtherisktobothmotherandfetus.75.ManagementExpectantdelivery2Management

expectanttreatment

Indication:

FewervaginalbleedingPatient’sconditionstabilization<36weeksgestation,fetalweight<2300g

Management:LyinginbedtotakearestInhibitionofuterinecontractionTreatmentaimatsymptomsPromotedevelopmentoffetusPreventionofinfection76.ManagementexpectanttreatmenTerminationofpregnancyCStotalplacentaprevia(36thweek),Partialplacentaprevia(37thweek)andheavybleedingwithshockPreventingpostpartumhemorrhage:pitocinandPGHysterectomy:PlacentaaccretaoruncontroledbleedingManagement

77.TerminationofpregnancyManage78.32.Vaginaldelivery

Marginalplacentaprevia

VaginalbleedingislimitedManagement

79.VaginaldeliveryManagement33.AdmittohospitalNOVAGINALEXAMINATIONIVaccessPlacentallocalizationCesareandeliveryisnecessaryinpracticallyallwomenwithplacentalpreviaManagement

80.Management34.PlacentaPrevia

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

81.PlacentaPrevia

ManagementSeveManagementofplacentaprevia?IndividualizedbasedonGestationalageAmountofbleedingFetalconditionandpresentation82.Managementofplacentaprevia?UltrasoundexaminationPlacenta

previaExpectantmanagementaslongasthebleedingisnotexcessive.Cesareandeliveryat36to37weeks’gestation83.UltrasoundexaminationPlacentEachofthefollowingisariskfactorofplacentapreviaexcept:A)Priorcesareansection;B)Hypertension;C)Multiplegestation;D)PrioruterinecurettageExercise1B84.EachofthefollowingisarisEachofthefollowingisatypicalfeatureofplacentapreviaexcept:A)Painlessbleeding;B)Commonlyassociatedwithcoagulopathy;C)Firstepisodeofbleedingisusuallyself-limited;D)AssociatedwithpostcoitalspottingExercise2B85.EachofthefollowingisatyA33-year-oldwomanat37week’sgestation,confirmedbyfirsttrimestersonography,presentswithmoderatedlyseverevaginalbleeding.Sheisnotedonsonographytohaveaplacentaprevia.Whichofthefollowingis