Transcript Pathology postpartum. Secondary postpartum hemorrhage

Saidjalilova D.D.
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Perinatology - the science of the fetus and its
development, the impact of external and internal
environment, diseases of the newborn, resulting
from violations of its womb.
Due to the close functional relationship and
interdependence of the utero-placental blood
flow and fetal became widespread, the term
"fetoplacental system", although to speak of the
mother-placenta-fetus.
Perinatal period - the time interval of 22 weeks
of fetal development on the 7th day of life of the
newborn.
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1. Ante2. Intra3. Postnatal
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In the antenatal period to reflect the state of
development of the fetus pregnancy and
abnormal pregnancy.
In the intrapartum period, the fetus is
influenced by deviations from the normal
course of childbirth, as well as their
combination with previous pathology of
pregnancy.
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1. in the antenatal period - 63%
2. in intrapartum - 21.2%
3. postnatal - 5.7%
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Especially vital in the fetus during pregnancy, the
fetus in the womb is as if in a sterile incubator,
where it provides oxygen, glucose, amino acids
and electrolytes. Practical benefits without
wasting energy on heat buildup, muscle work,
digestion and elimination processes. Most of the
energy of the fruit consumed by synthetic
processes, ie on growth and development. Fetus
responds to external stimuli mediated by the
mother's body. Direct stimuli of the fetus, in the
end, the following: Changes in quantitative and
qualitative terms, the receipt of necessary
materials for his life.
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1. Motherboard
2. Placental
3. Fetus during its internal development fetus
provides the vital needs of the placenta.
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Respiratory surface villous placenta late in pregnancy is 6-10 m2 (body
of an adult subject - 1,4-1,82). Through a complex mechanism naps
provide the fetus with oxygen saturation of the blood and removal of
CO2. However, during pregnancy, placental development can not keep
up the development of the fetus: the third month of pregnancy, the
placenta is increased by 15 times, the fruit - 800 times. Therefore,
fetuses develop compensatory mechanisms to ensure its survival in low
supply of oxygen - hypoxia. These include: Big V circulation (fetal heart
rate of 120-140 per 1 min.) The increased number of red blood cells 6. 1012 to 1 liter. Hb concentration - 210-230 g / l Hb increased
affinity for oxygen active fetal movement (speed reducing muscle blood
flow) Less need for oxygen Features fetal circulation (oxygenated blood
is distributed mainly in the liver and upper torso. Possibility of the
metabolic processes in the the absence of oxygen (anaerobic glycolysis).
Nevertheless, even in normal pregnancy the fetus in her late severe
shortages of oxygen. Timely delivery and resulting in the emergence of
infant pulmonary respiration save him from intrauterine death. cause
fetal hypoxia is fetoplacental insufficiency, which develops when:
Pregnancy Pathology Pathology birth mother extragenital diseases
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Diseases of the fetus (fetal napr.GB) placental insufficiency
is divided into: Chronic: Mts. anemia, heart, lungs, etc.
Placenta praevia, perenashivanie, hypertension, pregnancy,
Rh and ABO-conflict and other Acute : PONRP,
hemorrhagic shock, rupture of the vessel at plevistom
placentation, rod.sil abnormalities, uterine rupture,
impaired circulation in the vessels of the umbilical cord,
knot, loop loss, compression loops, the absolute and the
relative shortness of umbilical cord and other direct
methods for the detection of fetal threat status Register
Ultrasonic registration of motor activity of the respiratory
movements (in Tech. 20 min) fetal ultrasound scan
ultrasound biometry placenta amnioscopy, oretoskopiya
ECG and PCG fetal monitor Continuous monitoring for 3060 minutes to study the heart rate (cardiotocography).
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Therapy failure FPS based on the method and
products that will improve uterine blood flow and
increasing the utero-placental blood flow.
Principles of therapy: Vasodilation m n complex
relaxation of muscles of the uterus (tocolysis)
Improve metabolism of the myometrium and
placenta is achieved: bed rest (on the side, the
elimination of physical stress, emo-tional stress)
. Estrogenic hormones - improve the transport
function of the fetus (positive integer folliculin,
estradiol-dipropionate (20 thousand units / m c
/ o 12 hours), 2% -0.5 hexestrol / m, sigetin 1%
- 2 ml / m β-mimetics (tocolytics)
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Antispasmodic and vasodilator - aminophylline, baralgin,
maksigan, complamin (theophylline + nikotin.k-ta) Courant
(koronarorasshiryayuschego vessels of the placenta and fetus.)
ATP - improves metabolism of the placenta. Heparin five
thousand units in / m Breathing oxygen Antigipoksanty Solvte
vitamins and amino acids. Intrauterine infection of the fetus.
problem intrauterine infection - one of the leaders in obstetric
practice. It is due to high rates of infection during pregnancy,
childbirth and postpartum women, risk of impaired fetal growth
and birth of an affected child. Among the causes of perinatal
smetrtnosti share intrauterine infection is more than 30%.
presence of foci of infection in a pregnant woman feel important
risk factor for infection of the fetus and newborn. should
distinguish between such concepts as vnuriutrobnoe infection
and intrauterine infection. Under intrauterine fetal infection
involve the penetration of microorganisms into the fetus and its
contamination.
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Prenatal factors:
- Age> 35 years;
- Diabetes mother;
- Hypertension;
- Anemia;
- Bleeding (I or II trimester);
- Maternal infection;
- Premature rupture of membranes;
- Prolonged pregnancy;
- Disparity in labor;
- Medication (lithium carbonate, magnesium,
adrenergic blockers);
- Abuse of harmful substances;
- Malformation of the fetus;
- Reducing the mobility of the fetus;
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Intrapartum factors:
- Emergency cesarean section;
- Abnormal presentation;
- Premature birth;
- Fragile heart in the fetus;
- Tetany of the uterus;
- The introduction of drugs for the mother and less than four
or more than 24 hours before delivery;
- Accelerated labor;
- Prolonged labor (over 24 hours);
- A prolonged second stage of labor (more than 2 hours);
- Traces of meconium in the amniotic fluid;
- The loss of the umbilical cord;
- Detachment of the placenta;
- Placenta previa
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Is it possible to predict the need for neonatal
resuscitation-tion?
Higher risk needs resuscitation in the following cases:
- Preterm infants with a gestational age less than 35
weeks
- Children born in breech presentation, twins, triplets
- Infants with intrauterine growth
- Tachycardia or bradycardia in the fetus
- Repetitive variable decelerations, late decelerations
- Low fetal biophysical profile
- Meconium in the amniotic fluid
- Mother received painkillers or she performed
anesthesia
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The reasons for the oppression of the vital
functions in the newborn
Asphyxia - a progressive hypoxia, the
accumulation of CO2 and acidosis. This
process, if it goes far enough, can lead to
irreversible brain damage and even death. It
can also affect the function of other vital
organs.
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Physiology of asphyxia
Apnea
Primary apnea - not applicable to the receipt of O2 in the
child begins a long period of non-rapid breathing. If
asphyxia continues, breathing movements stop, heart rate
falls and the neuro-muscular tone is gradually reduced,
and the newborn begins a period of primary apnea.
Secondary apnea - for continuing asphyxiated baby
developing asthma, heart rate continues to fall, starts to
decrease blood pressure, and the child disappears almost
completely tone. Breathing becomes weaker, until the child
is doing the last heavy breath, followed by a period.
Distinguish between primary and secondary apnea is
difficult. For this reason, sleep apnea should be
considered as secondary, and without delay to the
intensive care unit.
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Removal of fetal lung liquid:
-Her light displacement and expansion may require
pressure, co-Thoroe two to three times greater than
the pressure required for normal breathing;
-Chest and can not be considered as the only
indicator of effective breathing.
Reduction of pulmonary blood flow in asfiktichnogo
baby usually is called pulmonary vasoconstriction.
The most important indicators of the newborn:
- Respiratory motion;
- Heart Rate;
- Colouring of skin.
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The cycle of "action-evaluation solution"
action action assessment decision
the child must be under
the ventilation
not breathing excessive
ventilation
tactile pressure light
stimulation
child to assess the heart
rate
breathing following
normal assessment
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you for attention