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前置胎盘的安太疗法 Anther therapy for anterior placenta 2008-9-19

  • 来源:cfl
  • 作者:cfl
  • 更新日期:2019-07-19 20:44
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孙玉葵,今天孕28突然阴道大量流血,2008-9-19急忙来到安太妇产医院,经四维彩超检查确诊为中央性前置性胎盘,急忙住院,2小时后转危为安,出血停止。 Sunyukui, today pregnant 28 sudden vaginal bleeding, 2008-9-19 rushed to the Antai maternity hospi

孙玉葵,今天孕28突然阴道大量流血,2008-9-19急忙来到安太妇产医院,经四维彩超检查确诊为中央性前置性胎盘,急忙住院,2小时后转危为安,出血停止。

Sunyukui, today pregnant 28 sudden vaginal bleeding, 2008-9-19 rushed to the Antai maternity hospital, confirmed by the four-dimensional color Super examination as a central anterior placenta, rushed to hospital, 2 hours later turned to safety, bleeding stop.

胎盘全部或部分位于胎儿的先露部前面,称为前置胎盘。前置胎盘是妊娠晚期出血的主要原因之一,为妊娠期的严重并发症,如处理不当,能危及母儿生命安全。

The placenta is completely or partially located in front of the foetus's first dew, called the anterior placenta. Preposition placenta is one of the main causes of bleeding in late pregnancy. It is a serious complication of pregnancy, such as improper management, which can endanger the life of the mother and child.

产前诊断:

Prenatal diagnosis:

出血,妊娠晚期突然发生无痛性反复阴道出血,即可疑为前置胎盘,如出血早,量多,则完全性前置胎盘的可能性大。

Bleeding, the sudden occurrence of painless repeated vaginal bleeding in the late stages of pregnancy, that is, suspicious of the placenta, such as early bleeding, more amount, the possibility of complete preplacenta.

B超:B型超声断层图像可清楚看到子宫壁、胎头、宫颈和胎盘位置,并根据胎盘边缘与子宫颈内口的关系可以进一步明确前置胎盘的类型。胎盘定位准确率达95%以上,并且可以重复检查,近年来国内外都已采用,基本取代了其他方法。

B ultrasound: B-type ultrasound tomography can clearly see the location of the uterine wall, fetal head, cervix and placenta, and can further clarify the type of anterior placenta based on the relationship between the placenta edge and the cervix inner mouth. The accuracy of placenta positioning is more than 95 %, and it can be repeated. In recent years, it has been adopted at home and abroad, basically replacing other methods.

提示:B型超声诊断前置胎盘时须注意妊娠周数,在妊娠中期超声检查约有30%胎盘位置低,超过内口,随着妊娠进展,子宫下段形成,宫体上升,胎盘即随之上移。因此如妊娠中期超声检查发现胎盘低置时,不要过早作前置胎盘的诊断,须结合临床考虑,如无出血,28周前不作此诊断。

Tip: B-type ultrasound diagnosis of the anterior placenta should pay attention to the number of weeks of pregnancy, in the middle of pregnancy ultrasound examination of about 30 % of the placenta position is low, exceeding the inner mouth, as the pregnancy progresses, the lower segment of the uterus forms, the uterus rises, the placenta will move up. Therefore, if a mid-term ultrasound examination of the pregnancy reveals that the placenta is low, do not diagnose the placenta prematurely. It must be combined with clinical considerations. If there is no bleeding, the diagnosis will not be made 28 weeks ago.

后产诊断:产前如有出血,分娩后仔细检查娩出的胎盘。前置部分的胎盘有陈旧血块附着呈黑紫色,如这些改变在胎盘的边缘,而且胎膜破口处距胎盘边缘小于7cm则为低置胎盘。

Post-birth diagnosis: if there is bleeding before the birth, carefully examine the placenta after delivery. The placenta in the anterior part has an old blood clot attached to the black purple, if these changes are on the edge of the placenta, and the placenta is lower at the edge of the placenta less than 7cm.

胎盘是由胎儿绒毛膜及母体子宫基蜕膜共同组成的扁盘状结构,附着在子宫壁上,通过脐带和胎儿相连,是胎儿与母体之间进行物质交换的唯一能量库。胎儿可以通过胎盘从母亲那里得到发育所必需的营养和氧气,并且通过胎盘排出代谢物。胎盘的正常附着处在子宫体部的后壁、前壁或侧壁。

The placenta is a flat disk structure composed of the fetal chorionic membrane and the maternal uterine molting membrane. It is attached to the uterine wall and is connected to the fetus through the umbilical cord. It is the only energy pool for material exchange between the fetus and the mother. The fetus can get the nutrients and oxygen necessary for development from the mother through the placenta and discharge metabolites through the placenta. The normal attachment of the placenta is in the posterior, anterior or lateral wall of the uterus.

对胎儿影响Impact on the fetus

胎儿发育缓慢:因为前置胎盘会引起胎盘供血不足,使胎儿吸收不到充足的养分而发育受限。胎位不正:如果胎盘堵住子宫口的话,宝宝就不能安稳地以头朝下的姿势固定住。容易引起横位或臀位。早产及围产儿死亡率增高:前置胎盘出血大多发生于妊娠晚期,容易引起早产。前置胎盘围产儿的死亡率亦高,可因产妇休克,使胎儿发生宫内窘迫、严重缺氧而死于宫内,或因早产生活力差,出生后死亡。

Fetal development is slow: because the anterior placenta will cause insufficient placenta blood supply, so that the fetus does not absorb sufficient nutrients and development is limited. Improper position: If the placenta blocks the uterus, the baby can not be firmly fixed in a downward position. It is easy to cause horizontal or hip positions. Preterm birth and perinatal mortality increased: Preposition placental hemorrhage mostly occurred in the late stages of pregnancy and was prone to premature birth. The mortality rate of preplacental perinatal infants is also high, and can be caused by maternal shock, resulting in intrauterine distress, severe hypoxia and death in the fetus, or due to poor premature birth and death after birth.

对母亲影响Impact on mothers

产后出血:分娩后由于子宫下段肌肉组织菲薄收缩力较差,附着于此处的胎盘剥离后血窦一时不易缩紧闭合,故经常会发生产后出血。

Postpartum hemorrhage: After delivery, due to the poor contraction of the muscle tissue in the lower segment of the uterus, the placenta attached to it is not easy to tighten and close after the placenta, so bleeding often occurs after production.

植入性胎盘:胎盘绒毛因子宫蜕膜发育不良等原因可以植入子宫肌层,前置胎盘偶见并发植入性胎盘,胎盘植入于子宫下段肌层,使胎盘剥离不全而发生大出血。

Implantable placenta: placenta Villi can be implanted in the uterine muscle layer due to hysterectomy and other reasons, the anterior placenta occasionally accompanied by the implanted placenta, the placenta implanted in the subuterine muscle layer, so that the placenta dissection is incomplete and hemorrhage occurs.

产褥感染:前置胎盘的胎盘剥离面接近宫颈外口,细菌易从阴道侵入胎盘剥离面,又加以产妇贫血,体质虚弱,故易发生感染。

Puerperal infection: the placenta of the anterior placenta is close to the outer cervix, bacteria easily invade the placental surface from the vagina, and maternal anemia, weak Constitution, so it is prone to infection.

处理:Processing:

期待疗法:妊娠36周前,胎儿体重小于2500g,阴道出血量不多,孕妇全身情况好,胎儿存活者,可采取此法。

Expected therapy: 36 weeks before pregnancy, the fetal weight is less than 2500 g, the amount of vaginal bleeding is not large, the pregnant woman's whole body is in good condition, the fetus is alive, you can take this method.

1.最好住院观察,绝对卧床休息;抑制宫缩;纠正贫血,必要时输血;.抗菌素预防感染;促进胎肺成熟。

1. It is best to stay in hospital for observation and absolute bed rest; Inhibiting contractions; To correct anaemia and, if necessary, blood transfusions; . Antibiotics to prevent infection; Promote fetal maturity.

2.严密观察病情,同时进行有关辅助检查,如B超检查、胎儿成熟度检查等,如大量出血、反复出血,或临产时,酌情终止妊娠。

2. Close observation of the condition, and at the same time perform related auxiliary examinations, such as B ultrasound examination, fetal maturity examination, such as massive bleeding, recurrent bleeding, or termination of pregnancy at the time of delivery.

自我护理:Self-care:

1.绝对卧床休息,选用高蛋白、高热量、高维生素、含铁丰富的食物;

1. Absolute bed rest, use high-protein, high-calorie, high-vitamin, iron-rich food;

2.尿频时注意宫缩及阴道出血情况;阴道似破水流液时要注意鉴别是否为出血;

2. Pay attention to contractions and vaginal bleeding when urinary frequency is high; When the vagina seems to break the fluid, care should be taken to identify whether it is bleeding;

3.左侧卧位,自数胎动,定时听胎心,间断吸氧;

3. The left side is lying, from the number of fetal movements, regular hearing of the fetal heart, intermittent oxygen absorption;

4.产前检查胎位动作要轻,避免刺激宫缩诱发阴道出血;

4. Prenatal examination fetal position action should be light, to avoid stimulation of contractions induced vaginal bleeding;

终止妊娠法:适于入院时大出血休克、前置胎盘期待疗法中又发生大出血休克、或近预产期反复出血、或临产后出血较多,都需要采取积极措施终止妊娠。终止妊娠的方式有二:

Termination of pregnancy method: suitable for admission to the haemorrhage shock, preposition placenta in the expectation of treatment and haemorrhage shock, or recurrent perinatal bleeding, or more bleeding after labor, all need to take positive measures to terminate pregnancy. There are two ways to terminate a pregnancy:

处理手段注意方法剖宫产术  剖宫产术可以迅速结束分娩,于短时间内娩出胎儿,可以缩短胎儿宫内缺氧的时间,增加胎儿成活机会,对母子较为安全。此种方式是处理前置胎盘的主要手段。术中注意选择子宫切口位置,尽可能避开胎盘。  由于子宫下段的收缩力差,胎儿娩出后,胎盘未即娩出,须及时作徒手剥离,同时注射麦角制剂增强子宫下段收缩及按摩子宫,减少产后出血量。如有胎盘植入须作子宫切除方能止血。阴道分娩  决定阴道分娩后,行手术破膜,破膜后胎头下降,压迫胎盘,达到止血,并可促进子宫收缩。  此法仅适用于边缘性前置胎盘而胎儿为头位。

Treatment Methods Caesarean section Caesarean section can quickly end delivery, deliver the fetus in a short period of time, can shorten the time of fetal hypoxia, increase the chances of fetal survival, and be safer for mother and child. This approach is the main means of dealing with preplacenta. During the operation, pay attention to choosing the location of the uterine incision and avoid the placenta as much as possible. Due to the poor contractility of the lower segment of the uterus, after the fetus is delivered, the placenta is not delivered immediately. It is necessary to remove the placenta in time. At the same time, the injection of ergot preparations enhances the contraction of the lower segment of the uterus and massages the uterus to reduce postpartum bleeding. If placenta implantation requires hysterectomy to stop bleeding. After vaginal delivery determines vaginal delivery, surgical rupture of the membrane, post-rupture of the membrane, reduction of the fetal head, compression of the placenta, to stop bleeding, and can promote uterine contraction. This method is only applicable to the marginal anterior placenta and the fetus is the head position.

产后新生儿的护理Care of newborns after childbirth

对出生后的新生儿应检查红细胞比例,了解其是否存在贫血、水肿及低蛋白血症。The rate of erythrocytes should be checked after birth to see if anemia, edema and hypoproteinemia are present.

除此之外,没有特别的需要护理的,如果因为早出血而提前剖宫产的早产儿,其护理方法与其它早产儿的护理方法一样。

In addition, there is no special need for care. If a premature baby is cesarean section due to early bleeding, the care method is the same as that of other premature babies.

产后对母亲的护理Postpartum care for mothers

前置胎盘的产妇子宫收缩能力差,子宫恢复得慢,恶露就会积聚在体内。所以,产后要给产妇适当按摩腹部,以帮助恶露排出。

The anterior placenta of the mother's uterine contraction ability is poor, the uterus recovery is slow, the evil dew will accumulate in the body. Therefore, after giving birth to the mother to massage the abdomen properly to help the evil dew discharge.

又因前置胎盘的胎盘剥离面接近宫颈外口,细菌易从阴道侵入胎盘剥离面,又加以产妇贫血,体质虚弱,易发生感染。所以产后要注意做好清洁,防止感染。

Because the placenta of the anterior placenta is close to the outer cervix, bacteria can easily invade the placental surface from the vagina, and then add maternal anemia, weak Constitution, and prone to infection. Therefore, after the birth should pay attention to do a good job of cleaning, prevent infection.

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