产妇出血。

PubMed ID
发表日期 2009年Dec月

原始出处 英国麻醉学杂志
British journal of anaesthesia
作者 Walfish  M  Neuman  A  Wlody  D 

文献标题 产妇出血。
Maternal haemorrhage.

文献摘要

孕产妇出血是全世界可预防的孕产妇死亡的主要原因,包括产前、产中和产后出血。这篇综述强调了导致严重出血的因素、处理方法以及最近的治疗和指南。产科护理的进步为医生提供了诊断工具,以检测、预测和预防大多数接受过产前护理的患者的严重危及生命的母体出血。在最佳的环境下,高出血风险的患者被转诊到三级护理中心,在那里多学科小组准备好护理和处理已知的潜在并发症。然而,即使有最好的产前护理,意外出血也会发生。管理的第一步是稳定血流动力学状态,包括确保大口径静脉注射、侵入性监测、积极的液体管理和输血治疗。对产妇出血患者的护理应遵循一种算法,通过一系列快速、连续的医疗和手术方法来阻止出血,降低发病率和死亡率。随着强有力的子宫药物的加入和微创介入放射学技术的出现,如血管造影栓塞和动脉结扎,明确而保守的管理现在是可能的,以避免子宫切除术的患者严重围产期出血。如果这些干预措施不足以控制出血,必须迅速决定进行子宫切除术。重组因子via是一种相对较新的治疗方法,可能被证明对严重凝血病和难治性出血有用。


Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.


获取全文 10.1093/bja/aep303