MacMullen Nancy J, Dulski Laura A, Meagher Barbara
Governors State University, University Park, IL, USA.
MCN Am J Matern Child Nurs. 2005 Jan-Feb;30(1):46-51.
The purpose of this article is to help nurses understand how to quickly and effectively manage the nursing care of patients with perinatal hemorrhage. The etiology, symptoms, medical management, and nursing care of the patient experiencing a perinatal hemorrhage are discussed. Hemorrhage during the antepartum, intrapartum, or postpartum period is a life-threatening emergency for the mother and/or fetus. Early antepartum hemorrhage (before 20 weeks gestation) can be related to abortion/miscarriage, ectopic pregnancy, or gestational trophoblastic disease; late antepartum hemorrhage (after 20 weeks gestation) may result from placental abruption and placenta previa. Intrapartum hemorrhage is most commonly due to placental abruption, or to uterine rupture, uterine inversion, invasive conditions of the placenta, or complications of Cesarean birth. Postpartum hemorrhage is defined as blood loss greater than 500 ml in a vaginal delivery or 1000 ml in a Cesarean birth; early postpartum hemorrhage occurs during the first 24 hours after delivery; late postpartum hemorrhage occurs after the first 24 hours after delivery. The most common cause of postpartum hemorrhage is uterine atony; however, lacerations, hematomas, and subinvolution of the uterus can also cause postpartum hemorrhage. Nurses who understand how to assess, plan, intervene, and evaluate outcomes for perinatal hemorrhage are in the position to prevent the major tragedies that can accompany hemorrhage in pregnancy and shortly afterward.
本文旨在帮助护士了解如何快速有效地管理围产期出血患者的护理工作。文中讨论了围产期出血患者的病因、症状、医疗处理及护理措施。产前、产时或产后出血对母亲和/或胎儿来说都是危及生命的紧急情况。早期产前出血（妊娠20周前）可能与流产、异位妊娠或妊娠滋养细胞疾病有关；晚期产前出血（妊娠20周后）可能由胎盘早剥和前置胎盘引起。产时出血最常见的原因是胎盘早剥，或子宫破裂、子宫内翻、胎盘侵入性疾病或剖宫产并发症。产后出血定义为阴道分娩时失血量超过500ml或剖宫产时超过1000ml；早期产后出血发生在分娩后的头24小时内；晚期产后出血发生在分娩后24小时之后。产后出血最常见的原因是子宫收缩乏力；然而，裂伤、血肿和子宫复旧不全也可导致产后出血。了解如何评估、计划、干预和评估围产期出血结果的护士，能够预防妊娠及产后不久出血可能带来的重大悲剧。
