指南速递 | 2019昆士兰临床指导：原发性产后出血(上)

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翻译：杨泓 何泽琳 邓诗蕾 黄启涛（南方医科大学南方医院妇产科 ）

审校：陈继明（南京医科大学常州临床医学院妇产科学教研室；南京医科大学附属常州第二人民医院妇产科）

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流程图：对产后出血的初始响应

流程图：大规模出血方案（MHP）

1.1

定义

1.3

病因

产后出血的常见原因被称为“四个T”(妊娠相关物残留、宫缩异常、创伤、凝血)，但可能存在不止一个原因(如宫缩异常和妊娠相关物残留)。

2.1

 风险因素

2.2 

产前风险管理

2.3 

产时风险管理

2.3.1 第三产程管理

在第三和第四产程期间提供的护理有助于预防或早期发现和治疗产后出血。参考昆士兰临床指南：第三产程常规管理的正常出生（41）。

2.3.2麦角新碱

2.3.3卡贝缩宫素

2.4

第四产程监护

如果发现产后出血（PPH）的高危因素，应在胎儿出生后立即监护一到两个小时。

2.5

 产后风险管理

审校专家

陈继明

陈继明，男，副主任医师，医学博士（博士后在站），硕士研究生导师。现任南京医科大学常州临床医学院妇产科学教研室主任，南京医科大学附属常州第二人民医院妇科病区主任，杏霖妇科内分泌研究院学术部部长/学术审核组组长。主要专业特长为妇科内分泌疾病、妇产科常见病诊治及妇科良恶性肿瘤的微创治疗，擅长单孔腹腔镜手术（LESS）及自然通道"无疤痕"腹腔镜手术（V-NOTES）。熟练掌握单孔腹腔镜下妇科良恶性肿瘤手术，并将5mm mini切口单孔腹腔镜手术广泛应用于妇科疾病的诊治。单孔腹腔镜技术曾获市卫计委医学新技术引进奖一等奖，第六届/第七届中国妇产科网手术视频大赛三等奖，第六届妇科肿瘤长江论坛青年医师优秀视频二等奖、2018江苏省抗癌协会妇科肿瘤专委会学术年会视频比赛二等奖，第六届/第七届SESGE优秀手术视频等。

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现为《中国计划生育与妇产科杂志》、《现代药物与临床杂志》、《国际妇产科前沿杂志》编委、《实用妇科内分泌杂志》中青年编委、《Life Research》editor；《World Journal of Gynecology & Women’s Health》associated editor；《重庆医学》、《中国性科学》、《中国肿瘤外科》、《安徽医药》等杂志特邀审稿专家。

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