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目的探讨晚期产后出血发生的预防及治疗措施。方法对23例晚期产后出血的临床表现及诊治情况进行回顾性分析。结果 B超怀疑胎盘胎膜残留行清宫6例,刮出物经病理证实:胎盘胎膜残留4例(其中1例因胎盘粘连严重转上级医院行介入治疗痊愈);阴道血肿1例经处理后4 d后无出血出院,5 d后再次出血多来院经保守治疗后痊愈出院;其余所有患者均获治愈、并且再无出血,无弥散性血管内凝血(DIC)及席汉氏综合征的发生。分析其主要病因为子宫复旧不良,其次依次为胎盘胎膜和(或)蜕膜残留、软产道损伤等。结论提高分娩质量,正确处理第三产程,提高剖宫产手术质量及产后支持治疗。预防感染及促进子宫收缩是预防晚期产后出血的关键。晚期产后出血发生后立即给予缩宫素及抗生素治疗、积极纠正休克、寻找出血原因并积极处理。
Objective To investigate the prevention and treatment of late postpartum hemorrhage. Methods The clinical manifestations, diagnosis and treatment of 23 cases of postpartum hemorrhage were analyzed retrospectively. Results 6 cases of suspected ultrasonography of placenta residual placenta occurred in Qing dynasty. The results of pathological examination showed that there were 4 cases of residual placental membranes (1 case was seriously transferred to upper-level hospital due to placental adhesion), 1 case of vaginal hematoma was treated 4 days after bleeding without discharge, bleeding again after 5 days more hospital to be cured after conservative treatment and discharged; all other patients were cured, and no bleeding, no disseminated intravascular coagulation (DIC) and Sheath’s syndrome . Analysis of the main causes of uterine involution of the poor, followed by the placenta and / or decidua, soft birth canal injury and so on. Conclusion To improve the quality of delivery, correctly handle the third stage of labor, improve the quality of cesarean section and postpartum supportive care. Prevention of infection and promotion of uterine contractions is the key to preventing postpartum hemorrhage. Late postpartum hemorrhage immediately after oxytocin and antibiotic therapy, and actively correct shock, to find the cause of bleeding and actively deal with.