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??????? (Antepartum and Postpartum Hemorrhage, APH

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(1) A. (Placenta previa) B. ... (Abruptio placentae) E. (Vasa previa) ... – PowerPoint PPT presentation

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Title: ??????? (Antepartum and Postpartum Hemorrhage, APH


1
??????? (Antepartum and Postpartum Hemorrhage,
APH PPH)
  • ???

2
???? (Antepartum Hemorrhage, APH)
3
????
  • ?? 28 ??,??????????

4
????
  • (1) ???????
  • A. ???? (Placenta previa)
  • B. ???? (Low lying placenta) ?????,??????
  • C. ?????? (Marginal sinus rupture)
  • D. ?????? (Abruptio placentae)
  • E. ???? (Vasa previa)???????,???????????????
  • F. ???? (Uterine rupture)
  • (2) ????????
  • A. ????????????
  • B. ?????????????????
  • (3) ????????
  • (4) ??????

5
???????????
  • (1) ????
  • A. ?????
  • B. ?????
  • C. ?????
  • D. ??????????
  • (2) ???????
  • A. ?????
  • B. ?????
  • C. ?????
  • D. ?? 20 ????????
  • E. NST?
  • F. ?????,????????,???????
  • G. ???????
  • H. ????????????
  • (3) ?????
  • A. CBC. PT. PTT. U/A
  • B. FDP. Fibrinogen (? Abruptio placentae ???)

6
????
  • A.??
  • B.???(Incidence)1/2000 pregnancies
  • C.?? ???????
  • D. ??
  • a. ?????? (lower segment) ???,??? "Migration"
    ?????????
  • b. ??????,?????????? Double set-up???????(??????,?
    ????? C/S)?

7
(No Transcript)
8
(2) ??????
  • A. ?????20??,?????????????????? (decidua
    basalis) ?????? ??
  • a. ????
  • b. ????
  • c. ???
  • B. ???(Incidence)1/100 pregnancies.
  • C. ???????
  • ? FDP ? Fibrinogen
  • ???????????
  • ?????????
  • ???
  • ???????? (Retro-placental hematoma)-??????????????
    ?????

9
(No Transcript)
10
(No Transcript)
11
  • G. ??
  • a. ????
  • b. ??????????,???? thromboplastin ????????,??
    fibrinogen ?????,??????,?????
  • c. ????????? (Consumptive Coagulopathy)
    ?????,???????C/S ??????
  • (a) Fresh whole blood500ml/unit.
  • (b) Cryoprecipitate20-25ml/unit.??? 025gm
    fibrinogen
  • (c) Fresh Frozen Plasma (FFP)200-250ml/unit,???
    fibrinogen 25mg.
  • (d) Platetet (? Pltlt50000/ul)35-50ml/unit.
  • (e) Platelet200-300ml/unit ? 12gm fibrinogen
  • (f) DIC ???
  • Platelet
  • Fibrinogen
  • FDP
  • PT
  • PTT
  • (g) ?? 24-28 ??? Hypofibrinogenemia ?????
    Coagulation factors ? 24 ??? Platelet ? 2-4 days
    ??????

12
  • H. ?????
  • a. ??????
  • b. Couvelaire ????????????????????
  • c. ?????????
  • ?????????? (ATN, Acute tubular necrosis.)

13
Couvelaire uterus
14
(3) ????
  • A. ????
  • ????????????????????????????????? (?????)?
  • B. ??
  • ????????
  • ????????????
  • ?????
  • ??????
  • ??????,
  • ?????????

15
  • C. ??
  • a. CBC,Coagulation profile
  • b. KUBsonography????????????????????
  • D. ????????
  • a. C/S??
  • b. ?a ??
  • ?? Hypogastric arteries ???? ???????? ???? ??
  • c. ?b ??,????
  • E. ??
  • a. ???????
  • b. ?????????(VBAC)?
  • (a) ?????
  • (b) ??? 20 ?????????
  • (c) ???
  • (d) ??????????

16
???? (Postpartum Hemorrhage PPH)
17
????
  • ??????,?????? 500ml
  • ???????
  • (1) Immediate
  • ??????? 24 ???????,??????,????????????????
  • (2) Late
  • ?? 24 ???,????????

18
????
  • (1) ???(Immediate)
  • A. ?????? (Uterine atony)
  • ????????????????????????
  • ???????,????????
  • ????
  • ????
  • ????????
  • B. ??????
  • ???????,???????,??????,?????????????????????????,?
    ?????? ?
  • C. ????? (Retained placenta)
  • ????????????????????????????,???,??????????
  • D. ????
  • ????,
  • ????? ???????????????????????? (Precipitate
    labor),
  • ???? ???????????
  • E. Hypofibrinogenemia
  • ??????????????,???????? Fibrinogen ????????

19
  • (2) Late
  • A. ?????
  • B. ????? (Intrauterine infection)
  • C. ?????? (Subinvolution)

20
??????
  • ???
  • (1) ????????????,????????????????
  • (2) ?????????????,???????????
  • (3) ????????????,?????????,?????????
  • (4) ?????????,????????,?????????????????
    Ergonovine,???????
  • (5) ?????????,??????????,?????
  • ???
  • (1) ?????????
  • (2) ??,?????????
  • (3) ???????,?????

21
A. ???????
  • a. ????????
  • b. ????,??????????,??????????,
  • c. ????
  • ?????? Ergonovine
  • ????? Pitocin ?????
  • ?????????????????,???? ???? ?? PGF2a?

22
B. ????
  • ????????,????????,?????????????
  • a. ??????????,??????????,???,??????
  • b. ????????????????????????,??????????????????

23
???????
  • C. ? 1/3 ?????????, ????????????, ?????
  • a. DC?
  • b. ???????
  • c. ?????

24
??????????
  • (1) ?? ??????????? 10?
  • (2) ????? (Tubular nephrosis)
  • ????? 80mmHg,????????,????????????,???????
  • (3) Sheehan's Synderome
  • ??????,?????????????,???????????????
  • (4) ????
  • (5) ????
  • ??????,??????,?????????????????,??????????,???????
    ????
  • (6) ???
  • ??????????????????????????

25
Thank for your listening
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