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PlacetalPreviaLongXiaoyu龍曉宇XuanWuHospital宣武醫(yī)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.后面內(nèi)容直接刪除就行資料可以編輯修改使用資料可以編輯修改使用資料僅供參考，實(shí)際情況實(shí)際分析45.后面內(nèi)容直接刪除就行45.感謝您的觀看和下載Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield46.感謝您的觀看和下載TheusercandemonstrPlacetalPreviaLongXiaoyu龍曉宇XuanWuHospital宣武醫(yī)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
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