1. 胎盘早剥

2. Definition After 20th week of pregnancy or during labor, a part or all of the placenta separates from the normal site before delivery of baby, it is named placental abruption

3. Etiology Vascular injury PIH syndrome chronic renal disease mechanical factors twins polyhydramnios short umbilical cord suddenly rising of the uterus venous pressure

4. Pathophysiology The hemorrhage in the decidua forming hematoma behind placenta separate from wall of the uterus

5. Classification A revealed abruption B concealed abruption C mixed hemorrhage

6. 显性出血

7. 隐性出血

8. 混和性出血

9. 病 例 王铭，女， 27 岁，以 “ 停经九个月，胎动五 个月，突发性下腹痛伴阴道流血一小时 ” 为主诉 入院。平素月经规律，早孕 反应不明显，孕 18 周觉胎动，活跃至今，一小时前无明显诱因突发 下腹痛，阴道 少量流血，鲜红，无意识模糊等 表现。 查体： T37.2 ℃， P21 次 / 分， BP85/55mmHg ， 心肺听诊无异常，腹 膨隆，孕足月腹， 纵产式 腹肌紧张，子宫易激惹，右下腹有一局限性压痛 点，阴道流血少量。

10. 实验室检查：血常 RBC2OO×10 12 /L ， HGB8.7g/L,WBC11.4×10 9 。 辅助检查： B 超示 BPD9.5cm ， FL7.4 cm, 胎盘位于后壁，与子宫间见一个 3× 5cm 低回声区，未见胎心反射。

11. Clinical manifestations Mild type during labor revealed abruption ＜ 1/3 in size vaginal bleeding slight abdominal pain uterus is soft fetal position is clear fetal heart sounds is clear

12. Severe type PIH symptoms concealed or mixed abruption ＞ 1/3 in size a lot of blood uterus enlarged rapidly increasing pain pallor out of proportion to amount of vaginal bleeding fetal position is not clear fetal heart sound disappear Clinical manifestations

13. Assistant examination B-ultrasound examination laboratory findings A the degree of anemia B funtion of coagulation

14. Diagnosis History signs examination assistant examination

15. Differential diagnosis Placenta previa impending rupture of uterus

16. Complications DIC and dysfunction clotting postpartum hemorrhage acute renal failure Sheehan, s syndrome

17. Prevention Improving prenatal care improving treatment for high risk pregnancy

18. Trestment ⑴ Correct shock terminating pregnancy A vaginal delivery B cesaerean section Preventing postpartum hemorrhage

19. Treatment ⑵ Treating the dysfunctional clotting A transfusing fresh blood B transfusing fibrinogen （纤维蛋白原） C transfusing fresh plasma D use of heparin （肝素） E anti-fibrinogenolysis agent （抗纤溶剂） preventing failure of renal function urine volume ＜ 30ml/h 补充血容量 ＜ 17ml/h 肾衰