JodetteHolly注冊助產(chǎn)士課件

JodetteHolly注冊助產(chǎn)士Recognisingscarrupture

如何識別疤痕破裂UterineRupture子宮破裂

Whathappens?會發(fā)生什么？Itcanhappenatanybirthparticularlywhensyntocinonisused任何分娩都可能發(fā)生，尤其是使用催產(chǎn)素時Twotypes兩種類型Catastrophic(symptomatic)theoldscareseparatesalongitlength,theamnioticsacrupturesandthebabyispushedoutintotheabdominalcavity.Thisresultsinsignificantbleeding,shock,andthebabyisingravedanger災難性的（有癥狀的）沿著舊疤痕的長度分開，羊膜囊破裂，嬰兒被推入腹腔。這會導致大出血、休克，并且嬰兒處于嚴重的危險之中Asymptomatic–thescarseparatespartwayalongitslength,theamnioticsacstaysintactandthebabyremainsintheuterus.Bleedingandshockisminimalandthebabyusuallysurvives.Thisisthemostcommontype無癥狀–沿疤痕長度部分分離，羊膜囊保持完好和嬰兒仍在子宮內(nèi)。出血和休克情況降到最小，嬰兒通常存活。這是最常見的類型。Signsofauterinerupture

子宮破裂的指征Cantbepredicted不可預測的Excessivevaginalbleeding陰道出血過多Sharppaininbetweencontractionsand/orsharppainatthescarsite宮縮間劇烈疼痛/疤痕部位的劇烈疼痛Unusalabdominalpainortenderness腹部異常疼痛或腹部壓痛Baby’sheadmovingbackupandnotdownthebirthcanal胎兒頭部向后移動不沿著產(chǎn)道下降Baby’sheadisbulgingunderthepubicbone,indicatingtheheadisoutsidethepelvis胎兒頭部在恥骨下鼓起來，表明頭部在骨盆外面Theuterususesmuscletone子宮肌肉緊張Rapidheartrateandabnormallylowbloodpressure心率過快和血壓異常低Theriskisreducedif…

如何降低風險Labourbeginsonitsownandcontinueswithoutdrugstostimulatetheuterinecontractions自然發(fā)動產(chǎn)程且不用藥物刺激子宮收縮Duedate18mthsafterthecaesarean距離上次剖宮產(chǎn)術(shù)后間隔18個月Lowertransversescar位置較低的橫向疤痕PrevioussuccessfulVBAC以往成功的剖宮產(chǎn)術(shù)后陰道分娩Preformedforotherreasonsapartfromobstructedlabour除梗阻性分娩外的其他原因Oneprevioussection第一次剖宮產(chǎn)Doublelayersuture雙層縫合Riskbynumbers風險概率9950outof10,000willnotrupture萬分之9950不會發(fā)生破裂1in200willrupture1/200的概率會破裂199outof200willnotrupture199/200將不會破裂0.5%willrupture0.5%的概率會發(fā)生破裂99.5%willnotrupture99.5%的概率將不會發(fā)生破裂TheabsoluteriskofbirthrelatedperinataldeathassociatedwithVBACisextremelylowan