胎盘早剥出血类型 ·外出血 内出血 出血突破胎盘和子宫血液隐匿在胎盘和子宫 壁附着处 肌壁中,未突破周围 胎膜附着处 对大多患者,隐匿的血液迟早会突破胎盘周 围胎膜,表现为外出血型
胎盘早剥出血类型 • 外出血 出血突破胎盘和子宫 壁附着处 • 内出血 血液隐匿在胎盘和子宫 肌壁中，未突破周围 胎膜附着处 对大多患者，隐匿的血液迟早会突破胎盘周 围胎膜，表现为外出血型
胎盘病理 >胎盘部位血管畸形常见( vascular abnormalities.) >未完成胎盘部位血管动脉转化(60%) >肌层内血管畸形,包括血管阻塞、肌层 内血管出血(33%)
胎盘病理 ➢ 胎盘部位血管畸形常见（vascular abnormalities.） ➢ 未完成胎盘部位血管动脉转化(60%). ➢ 肌层内血管畸形，包括血管阻塞、肌层 内血管出血（ 33%）
sher分级( internationa) Grade I: Slignt vaginal bleeding and some uterine irritability are usually present. Maternal blood pressure is unaffected, and the maternal fibrinogenlevel is normal. The fetal heart rate patternis normal Grade Il: Externaluterine bleeding is mild to moderate. The uterus is irritable, and tetanic or very frequent contractions may be present. Maternal blood pressure is maintained, but the pulse rate rate may be elevated and postural blood decreased The fetal heartrate often shows signs of fetal e volume deficits may be present. The fibrinogen level may be compromise. Grade Il: bleeding is moderate to severe but may be concealed. The uterus is tetanic and painful. Maternal hypotension is frequently present and fetal death has occurred. Fibrinogen levels are often reduced to less than 150 mg/dl; other coagulation abnormalities (thrombocytopenia, factor depletion) are present
Sher分级 (international) ➢ Grade I: Slignt vaginal bleeding and some uterine irritability are usually present. Maternal blood pressure is unaffected, and the maternal fibrinogen level is normal. The fetal heart rate pattern is normal. ➢ Grade II: External uterine bleeding is mild to moderate. The uterus is irritable, and tetanic or very frequent contractions may be present. Maternal blood pressure is maintained, but the pulse rate rate may be elevated and postural blood volume deficits may be present. The fibrinogen level may be decreased. The fetal heart rate often shows signs of fetal compromise. ➢ Grade III: bleeding is moderate to severe but may be concealed. The uterus is tetanic and painful. Maternal hypotension is frequently present and fetal death has occurred. Fibrinogen levels are often reduced to less than 150 mg/dl; other coagulation abnormalities (thrombocytopenia, factor depletion) are present
胎盘早剥分级(中国) 轻型 重型 出血 外出血为主,剥离面积不隐匿型或混合型出血为主 超过胎盘面积1/3,发生在剥离面积超过1/3,发生于先 产程中 兆子痫和慢性高血压患者 症状 阴道出血,轻微腹痛、腹腹痛、伴随休克症状 胀,无贫血 体征 子宫软,正常收缩,宫体子宫硬和宫体压痛,宫底逐 压痛,正常胎心率 渐增高,宫缩频,胎心率过 快或过慢,以及胎儿宫内死
胎盘早剥分级（中国） 轻型 重型 出血 外出血为主，剥离面积不 超过胎盘面积1/3，发生在 产程中 隐匿型或混合型出血为主， 剥离面积超过1/3，发生于先 兆子痫和慢性高血压患者 症状 阴道出血，轻微腹痛、腹 胀，无贫血 腹痛、伴随休克症状 体征 子宫软，正常收缩，宫体 压痛，正常胎心率 子宫硬和宫体压痛，宫底逐 渐增高，宫缩频，胎心率过 快或过慢，以及胎儿宫内死 亡
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