ТМА lecture for students 4 courses of therapeutic faculty obstetric bleeding prof. jabbarova y.k
TRANSCRIPT
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ТМА lecture for students 4 courses
of therapeutic faculty OBSTETRIC BLEEDING
Prof. Jabbarova Y.K.
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Maternal mortality: global tragedyAnnually 585, 000 women die of pregnancy complications
99% in the developing worlds
~ 1% in industrial countries
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Каждую минуту...
Hours of maternal mortality
380 women pregnant
190 women with unplanned and unwanted pregnancy
110 women passes through complications, caused by pregnancy
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Каждую минуту...
Hours of maternal mortality
40 women
Make
Criminal abortion
1 woman die from complications in pregnancy time and after births of children
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Global causes of maternal mortality
24.8
14.9
12.96.912.9
7.9
19.8
Кровотечение 24,%
Инфекция 14,9%
Эклампсия 12,9%
Затяжные роды6,9%Криминальныйаборт 12,9%Другие прямыепричины 7,9%Косвенныепричины 19,8
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ЭОВ; 2,0%
ЭГЗ; 16,1%
Сепсис; 15,2%
Гестоз; 15,3%
Кровотечение; 51,4%
Structure of maternal mortality
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Obstetrics bleeding
Obstetrics bleeding in structure of maternal mortality steadily occupy leading the place.
The frequency them range from 28% up to 50% variously republic regions 0001 the frequency
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Obstetrics bleeding during pregnancy
I half:
• Abortions
• Ectopic pregnancy
• Molar pregnancy
II half: • The premature
detachment is normal disposed placenta
• Placental presentation
• Uterine ruptures
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Obstetrics bleeding during labor
I and II period:
1. The premature abruptio is normal disposed placenta
2. Placental presentation
3. Uterine ruptures
III period:
1.Partial dense fastening of placenta
2.Afterbirth restriction
3.Hypo and metratonia
4. Injuries of soft maternal passages
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Postpartum hemorrhages:
Early: - <4 tons> 1.Parts delay of afterbirth
(fabric ) 2.Hypo and metratonia
(tonus ) 3. Injuries of soft maternal
passages 4.D I C- syndrom
(thrombus )
Late:
1. Parts delay of afterbirth
2. Endometritis
3. Subinvolution
4. Lochiometra
5. Fibromyoma
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Obstetric bleeding (unentangled with pregnancy )
Cervical erosion Cervix cancer Varicosis Injuries of soft maternal
passages Cervical polyps
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Causes of bleedingCauses of bleeding
Out-and-out placental detachment - 35%
Complete presentation - 15%
After septic shock - 8%
Inborn and acquired disorders of haemostasis - 7%
Anesthetic, stillbirth - 3%
Amniotic fluid embolism -?
Hypotonia - 88%
Partial placental separation - 3%
Incomplete placental presentation - 3%
massive mild
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Premature Detachment
is normal Disposed Placenta
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Etiology• Hypertension • Renal disease • Anaemia • Rheumatismus • Diabetes mellitus • Multiple pregnancy • Dropsy of amnion • Short umbilical cord • Entire amniotic bag
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PathogenesisBreak of uteroplacental capillaries:
A. Centered on:
Retroplacental hematoma
Uterus of Cuveler
B. With territory:
External hemorrhage
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DIAGNOSISTopalgia
Violation of fetal heart sound
USE: retroplacental hematoma
Vaginal bleeding
Symptoms of hemorrhagic shock
Thrombocytopenia, fibrinopenia
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COMPLICATIONS
Hemorrhagic shock Overvoltage limiter DIC-syndromAsphyxia and fruit death Maternal mortality
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TREATMENTCesarean section Amputation Extirpation Dressing of a. iliaca interna
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PLACENTA PREVIA
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CLINIC
Bleeding: • Painless • Without presence EGD and hypertension • Abrupt • Repetitive • Plentiful • Than lower are arranged placenta before
gestational age begins the bleeding (even with 13-16 weeks )
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TACTIC
Pregnancy conservation:
Rest
Bed rest
Antispasmodic drugs
Tocolytics
Progestagens, gestagens
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TACTIC
Caesarean section:
Central and side presentation
Term 36-37 weeks
Hemorrhea
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Early recognition and help challenges:
State estimating PS, BP,
Colour of dermal covers,
Awareness
T bodies,
Respiration rate,
Vaginal precipitations, urination
Challenges of ambulance and transporting in permanent establishment 2 and 3 levels
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Primary of intensive care:
To setup one or two intravenous catheter tube of large diameter (the size 16 or more )
To start the introduction (1 litre for 15 minutes ) cristalloid
Saline solution:
At the rate of 3мл of solution to 1 bloodloss magnetic tape
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Primary of intensive care:
At hand of shock sign, additionally: - lower down the head - to free respiratory tract To provide the oxygen supply through mask (6-8 l/min) To heat up the woman (to draw the blanket over, to interchange wet sheets on dry )
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Why die these woman?The belated decision request assistance Lack of understanding of complication Receivability of maternal mortality Low social women status Social and cultural hedges to get help Later help receipt Mountains, islands, rivers - imperfect organisation of transporting Later help receipt Resources, personnel Poorly trained staff when penalty system Financial difficulty
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Thank you for your attention!