產(chǎn)后出血搶救規(guī)程出血量＞1500ml擴(kuò)容給氧監(jiān)測出血量，生命體征和尿量，血氧飽和度，生化指標(biāo)按摩子宮宮縮劑使用宮縮水囊或紗條填塞B-Lynch及其他子宮縫合術(shù)子宮血管結(jié)扎縫合裂傷清楚直徑＞3CM血腫恢復(fù)子宮解剖位置補(bǔ)充凝血因子，新鮮冰凍血漿，冷沉淀，凝血酶原復(fù)合物，血小板等人工剝離刮宮等宮縮乏力產(chǎn)道裂傷胎盤因素凝血功能障礙休克指數(shù)（SI）＝脈搏/收縮壓SI=0.5血容量正常SI≥1時(shí),表示血容量約減少10%～30%,屬輕度休克SI≥1.5時(shí),表示血容量減少30%～50%,屬中度休克SI≥2時(shí),表示血容量減少50%～70%,屬重度休克。繼續(xù)抗休克和病因治療呼吸管理、容量治療DIC的治療使用血管活性藥物糾正酸中毒，應(yīng)用維生素必要時(shí)結(jié)扎子宮動(dòng)脈重要臟器功能保護(hù)：心，肝，肺，腎等重癥監(jiān)護(hù)（麻醉科，血液科，ICU等）危重線：三級急救處理病因治療抗休克治療處理線：二級急救處理出血量：500-1500ml出血量＞1500ml擴(kuò)容給氧監(jiān)測出血量，生命體征和尿量，血氧飽和度，生化指標(biāo)按摩子宮宮縮劑使用宮縮水囊或紗條填塞B-Lynch及其他子宮縫合術(shù)子宮血管結(jié)扎縫合裂傷清楚直徑＞3CM血腫恢復(fù)子宮解剖位置補(bǔ)充凝血因子，新鮮冰凍血漿，冷沉淀，凝血酶原復(fù)合物，血小板等人工剝離刮宮等宮縮乏力產(chǎn)道裂傷胎盤因素凝血功能障礙休克指數(shù)（SI）＝脈搏/收縮壓SI=0.5血容量正常SI≥1時(shí),表示血容量約減少10%～30%,屬輕度休克SI≥1.5時(shí),表示血容量減少30%～50%,屬中度休克SI≥2時(shí),表示血容量減少50%～70%,屬重度休克。繼續(xù)抗休克和病因治療呼吸管理、容量治療DIC的治療使用血管活性藥物糾正酸中毒，應(yīng)用維生素必要時(shí)結(jié)扎子宮動(dòng)脈重要臟器功能保護(hù)：心，肝，肺，腎等重癥監(jiān)護(hù)（麻醉科，血液科，ICU等）危重線：三級急救處理病因治療抗休克治療處理線：二級急救處理出血量：500-1500ml求助建立兩條可靠的靜脈通道吸氧監(jiān)測生命體征和尿量檢查血常規(guī)，凝血功能，交叉配血積極尋找原因并處理產(chǎn)后2H內(nèi)出血＞400ml預(yù)警線：一級急救處理

臀位分娩的處理若孕婦已臨產(chǎn)，且符合以下條件，1、孕周＞36周，2、單臀先露，3、估計(jì)胎兒體重＜3500g，4、骨盆大小正常?？稍谝苿?dòng)產(chǎn)房進(jìn)行臀位助產(chǎn)法娩出胎兒。分娩過程中能夠由有豐富經(jīng)驗(yàn)的產(chǎn)科醫(yī)師及助產(chǎn)士共同觀察產(chǎn)程。分娩時(shí)需新生兒科醫(yī)師在場處理新生兒。產(chǎn)時(shí)需要有持續(xù)監(jiān)測胎心的電子監(jiān)護(hù)儀，嚴(yán)密觀察胎心率的變化。分娩過程中需作好急診剖宮產(chǎn)及處理產(chǎn)后出血的準(zhǔn)備工作。 臀位若未臨產(chǎn)，嚴(yán)密進(jìn)行母胎監(jiān)測。積極轉(zhuǎn)運(yùn)至?？漆t(yī)院進(jìn)行進(jìn)一步治療。

子癇搶救流程子癇子癇一般處理平臥、側(cè)頭、置開口器避光、聲刺激清理呼吸道、給氧了解病史一般處理平臥、側(cè)頭、置開口器避光、聲刺激清理呼吸道、給氧了解病史記錄生命征導(dǎo)尿記尿量開放靜脈路開放靜脈路降壓肼苯噠嗪12.5～25mg酚妥拉明20～40mg2、解痙硫酸鎂5g，沖擊20g，維持1、控制抽搐冬眠一號半量安定、魯米那納降壓肼苯噠嗪12.5～25mg酚妥拉明20～40mg2、解痙硫酸鎂5g，沖擊20g，維持1、控制抽搐冬眠一號半量安定、魯米那納3、擴(kuò)容白蛋白、血低右預(yù)防感染，首選預(yù)防感染，首選青霉素或頭孢類產(chǎn)科處理處理并發(fā)癥血生化監(jiān)測產(chǎn)科處理處理并發(fā)癥血生化監(jiān)測顱內(nèi)出血腦水腫腦疝心衰腎衰糾正酸中毒及水電解質(zhì)紊亂顱內(nèi)出血腦水腫腦疝心衰腎衰糾正酸中毒及水電解質(zhì)紊亂未臨產(chǎn)臨產(chǎn)未臨產(chǎn)臨產(chǎn)快速脫水甘露醇、速尿快速脫水甘露醇、速尿抽搐血短控壓期制未內(nèi)2控不～制能8腦部低溫分小腦部低溫娩時(shí)縮短第二產(chǎn)程止血?jiǎng)┛s短第二產(chǎn)程止血?jiǎng)?qiáng)心劑利尿劑剖宮產(chǎn)剖宮產(chǎn)ManagementofthePatientWithPostpartumHemorrhageI.GeneralMeasures:EvaluateexcessivebleedingimmediatelyAssessoverallpatientstatus?Notifyothermembersofobstetricsteam(i.e.,obtainhelp!)?Reviewclinicalcourseforprobablecause??Anydifficultyremovingplacenta???Wereforcepsused???Otherpredisposingfactors??HaveoperatingroomandpersonnelonstandbyMonitorandmaintaincirculation?EstablishIVaccess:2largebore??Typeandcross-matchblood??Begin/increasecrystalloidinfusion??AssessforclottingorcheckcoagulationprofileII.Evaluation:PerforminRapidSuccessionAssesshemodynamicstatus?Bimanualexamination:assessforatony??Maypalpateforretainedplacentalfragments?Maypalpateuterinewallforrupture?Inspectperineum,vulva,vagina,andcervix??Identifylacerations,hematomas,inversions??Recruitassistanceforexposure??Youorassistantmayre-inspectplacentaAssessclottingIII.TargetedInterventionsIV.AtonyImmediatebimanualmassage?Administeruterotonics(withrequisiteprecautions)?Oxytocin—IV:10–40units/1LnormalsalineorlactatedRingersolution,continuous?Methylergonovine—IM:0.2mgIM;mayrepeatin2–4hours?15-methylPGF2—IM0.25mgevery15to90minutesforupto8doses?Dinoprostone—Suppository:vaginalorrectal;20mgevery2hours?Misoprostol—800–1000μgrectally;onedose??Intrauterinetamponade—Bakriballoon,packingOperativemeasures?Uterinecompressionsutures?SequentialarterialligationorselectivearterialembolizationHysterectomyV.Retainedplacenta1.Manualremoval;manageatonyasabove2.Ultrasoundassessment/guidancetoassurecompleteremoval?3.Suctioncurettage—ideallyperformedwithultra-soundguidanceinoperatingroom(OR)4.Maintainsuspicionforaccreta—additionalinterventionrequiredVI.Genitaltractlacerationsandhematomas1.Repairlacerationsimmediately2.Exposurecritical—getassistance,movetoOR3.Noblindlyplacedsutures?4.Packingmaybenecessary?5.Observestable,asymptomatichematomasVII.Coagulopathy1.Appropriatefactorreplacement?2.Identifyunderlyingcause?3.Hemorrhage,infection,amnioticfluidembolism

ManagementWithBreechPresentationCesareandeliverywillbethepre-ferredmodeformostphysiciansbecauseofthediminishingex-pertiseinvaginalbreechdelivery.Plannedvaginaldeliveryofatermsingletonbreechfetusmaybereasonableunderhospital-specificprotocolguidelinesforbotheligibilityandlabormanagement.Thefollowingcriteriahavebeensuggestedforvaginalbreechdelivery:1.Normallaborcurve2.Gestationalagegreaterthan37weeks?Frankorcompletebreechpresentation.Becauseoftheriskofumbilicalcordprolapse,vaginaldeliveryofafetusinthefootlingbreechpositionisnotrecommended.??Absenceoffetalanomaliesonultrasoundexamination?Adequatematernalpelvis??Estimatedfetalweightbetween2500gand4000g??Documentationoffetalheadflexion.Hyperextensionofthefetalheadoccursinabout5%oftermbreechfetuses,requiringcesareandeliverytoavoidheadentrapment.?Adequateamnioticfluidvolume(definedasa3-cmver-ticalpocket)??AvailabilityofanesthesiaandneonatalsupportPhysiciansneedtodealwiththepresenceofneonatalnewbornduringchildbirth.Theneedforcontinuousmonitoringofelectronicfetalheartratemonitorintrapartum,observationofchangesinfetalheartrate.Deliveryprocessrequiredtomakeemergencycesareansectionandtreatmentofpostpartumhemorrhagepreparations.

ManagementWithEclampsiaEclampsiaEclampsiaEmergencymanagnmentsupine、LUD、restraining、insertthetongueblade、preventaspiration、openairwayandprovideoxygenHistoryEmergencymanagnmentsupine、LUD、restraining、insertthetongueblade、preventaspiration、openairwayandprovideoxygenHistoryMonitorPlacetheFolyecatheterIVIVAntihypertensionHydralazineαβ-epinephrineRblockerAntispasmodicsMAntihypertensionHydralazineαβ-epinephrineRblockerAntispasmodicsMagnesiume25%MgSO410mL+5%GS20mLiv25%MgSO460mL+5%GS500mLivgttRegimen（2）25%MgSO420mL+procaine2mLimControlofseizuresPethidineChlorpromazinepromethazinepethidine100mgchlorpromazine50mgpromethazine50mgppethidine100mgchlorpromazine50mgpromethazine50mgthidine100mgchlorpromazine50mgpromethazine50mgExpansionAlbumin、blood、DextranPreventinfectionPreventinfectionPreventcomplica