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【胎膜残留】胎盘胎膜残留所致晚期产后出血的临床处理

时间:2019-03-17来源:南来北往网 -[收藏本文]

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doi:10.3969/j.issn.1007-614x.2014.14.34
摘 要 目的:总结胎盘胎膜残留所致晚期产后出血的临床处理经验。方法:2012年3月-2013年12月收治胎盘胎膜残留所致晚期产后出血患者80例。药物治疗:给予生化颗粒冲剂15g,3次/日,早晨空腹服米非司酮7.5mg,两种药物均治疗6天。手术治疗:对于出血量较大、出血休克的患者应立即清宫,术后使用催产素、止血剂、抗生素等对症治疗。结果:80例患者中,采用药物治疗20例,药物治愈14例(70.0%),另外6例药物治疗失败后行清宫术治愈。另外60例患者直接采用清宫术治疗,胎盘、胎膜残留物,手术治愈。结论:生化颗粒冲剂和米非司酮是药物治疗胎盘胎膜残留所致晚期产后出血的药物治疗方法,清宫术是手术治疗胎膜残留所致晚期产后出血重要手段。临床可根据患者的具体情况选择治疗方法。
关键词 胎盘胎膜残留 晚期产后出血 生化颗粒冲剂 米非司酮 清宫术
Clinical treatment of late postpartum hemorrhage due to retained placenta
Jiao Tongxin
Department of obstetrics of Maternal and Child Health Hospital of Huixian city in Henan Province,453600
Abstract Objective:To summarize the experience of clinical management of late postpartum hemorrhage due to the retained placenta.Methods:80 patients with late postpartum hemorrhage due to retained placenta were admitted in our hospital 癫痫病服什么药from March 2012 to December 2013.Drug treatment:give biochemical granules 15g,3 times/day,morning fasting mifepristone 7.5mg,both drugs were 6 days treatment.Surgery:For a large amount of bleeding and hemorrhagic shock patient should curettage immediately,and then should be used of oxytocin,hemostatic agents,antibiotics and other symptomatic treatment after surgery.Results:Among 80 patients,20 patients used the drug treatment, the drug cured 14 cases(70.0%),while 6 cases were cured underwent curettage after drug treatment fails.Another 60 patients were used curettage treatment directly,both the placenta,fetal membranes residues,surgical cure.Conclusions:Biochemical and mifepristone granules are drug treatment methods in late postpartum hemorrhage caused by retained placenta,and surgical curettage is important treatment in late postpartum hemorrhage caused by residual placenta.Clinical can choose of treatment according to the specific condition of the patient.
Key words Retained placenta;Late postpartum hemorrhage;Biochemical granules;Mifepristone;curettage
分娩24小时以后出血>500ml者为济南癫痫病医院评价晚期产后出血[1],是导致产妇死亡的重要原因之一,胎盘胎膜残留是导致晚期产后出血的主要原因。为总结胎盘胎膜残留所致晚期产后出血的临床处理经验,2012年3月-2013年12月收治胎盘胎膜残留所致晚期产后出血患者80例,对其治疗方法及效果进行总结,现报告如下。
资料与方法
2012年3月-2013年12月收治胎盘胎膜残留所致晚期产后出血患者80例,年龄23~36岁,平均28.5岁,其中初产妇62例,经产妇18例,孕周37~43周,平均40.6周。分娩方式:经阴道分娩86例,剖宫产4例。所有患者均表现为胎盘剥离后检查不完整。
方法:①药物治疗方法:给予生化颗粒冲剂15g,3次/日,早晨空腹服米非司酮7.5mg,两种药物均治疗6天。②手术治疗:对于出血量较大,出血休克的患者应立即行清宫术。术后使用催产素、止血剂、抗生素等对症治疗。
结 果
80例患者中,采用药物治疗20例,药物治愈14例(70.0%),其余6例药物治疗失败后行清宫术治愈;60例患者直接采用清宫术治疗,均胎盘、胎膜残留物,手术治愈。
讨 论 晚期产后出血是导致产妇死亡的重要原因之一,胎盘胎膜残留是导致晚期产后出血的主要原因。
胎盘残留:在分娩时的第3产程,如果处理不当,过早牵拉娩出胎盘,未能及时发现残留在宫腔内的大块胎盘缺损或副胎盘,残留的胎盘组织会发生变性、坏死、机化,胎盘息肉形成。当胎盘息肉发生坏死脱落,其基底部的血管会破裂出血。临床症状通常表现为红色恶露时间延长,产后发生反复出血,甚至是突然的大出血、失血性休克,通常是在产后10天左右发生。妇科检查可见复旧不全的子宫,子宫口松弛,可能还会有残留的组织堵塞子宫口。患者可出现发热症状,B超检查结果显示子宫内膜线不清,宫腔内出现强光团回声,还可能出现暗区间杂其中,刮宫后对刮出物进行病理检查,发现绒毛组织。
胎膜残留:还可导致晚期产后出血,主要症状为长时间持续性红色恶露,很少出现大出血的症状[4,5]。妇科检查可见子宫复旧不良,B超检查结果显示子宫内膜线不清,宫腔内存在细小强光团回声。宫腔刮出物病理检查有胎膜组织。
胎盘附着部位子宫复旧不全或子宫内膜修复不全:胎盘排出后,子宫胎盘附着部位血管即形成血栓,随后血栓机化,发生透明样变,血管上皮增厚,管腔狭窄、堵塞。胎盘附着部位边缘的子宫内膜向内生长,底蜕膜深层的残留腺体和内膜重新生长,使子宫内膜得到正常修复,通常这一过程需要6~8周完成。如果该部位产生感染,血栓脱落,血窦重新开放的现象,就会引发大出血。多发生在产后2~3周,妇科检济南哪里治疗癫痫病最好查表现为子宫增大、软,宫口松弛,有时可见大量血块堵塞,按摩子宫会排出陈旧性血液或凝血块。
本研究结果表明,生化颗粒冲剂和米非司酮是药物治疗胎盘胎膜残留所致晚期产后出血的药物治疗方法,清宫术是手术治疗胎膜残留所致晚期产后出血重要手段。临床可根据患者的具体情况选择治疗方法。
参考文献
1 崔静妍,赵晓娟,赵丽梅.晚期产后出血的原因及预防临床分析[J].中国医药导报,2009,6(18):153-156.
2 Dansereau J,Joshi AK,Helewa ME,et al.Double-blind comparison of carbetocin versus oxytocin in prevention of uterine atony after cesarean section[J].Amj Obster Gynecol,1999,180(3):670-676.
3 Holtsema H,Nijland R,Huisman A,et al.The B-lynch technique for ostartumhaemorrhage:an option for every synaecologist[J].Eur J Obstet Gynecol Reprod Biol,2004,115(1):39-42.
4 Wax JR,Chawnell JC,Nandersloot JA.Packing of the lower uterine seg-ment-new approach to an old technique[J].Int J Gynecol Obstet,1993,43(2):197-198.
5 Micgelle A,Harden MD,Valente PT.Postabortal hemorrhage due to placenta increta:a case report[J].Am J Obstet Gynecol,1990,75(3):523-526.

Abstract:

Objective:To summarize the experience of clinical management of late postpartum hemorrhage due to the retained placenta.Methods:80 patients with late postpartum 南京的癫痫病医院那个专业hemorrhage due to retained placenta were admitted in our hospital from March 2012 to December 2013.Drug treatment:give biochemical granules 15g,3 times/day,morning fasting mifepristone 7.5mg,both drugs were 6 days treatment.Surgery:For a large amount of bleeding and hemorrhagic shock patient should curettage immediately,and then should be used of oxytocin,hemostatic agents,antibiotics and other symptomatic treatment after surgery.Results:Among 80 patients,20 patients used the drug treatment, the drug cured 14 cases(70.0%),while 6 cases were cured underwent curettage after drug treatment fails.Another 60 patients were used curettage treatment directly,both the placenta,fetal membranes residues, surgical cure.Conclusions:Biochemical and mifepristone granules are drug treatment methods in late postpartum hemorrhage caused by retained placenta,and surgical curettage is important treatment in late postpartum hemorrhage caused by residual placenta.Clinical can choose of treatment according to the specific condition of the patient.

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