INTERVIEW

• Lily. She is a happy mother now. But just about two months ago, she is not so lucky.

• Lily is a beautiful girl. She has married four years ago.

• In the first year she experienced two artificial abortions.

• In the second year another natural abortion came.

• In the third year she got pregnant again. She felt normal until the 33 weeks, she felt abdominal pain and bloodstain under her buttocks.

• After examination, everything is normal except the placenta located the frontage of the uterus which partially covers the internal os.

• She was given oxygen by mask and sulphuric acid magnesium and was told to lie on the left side and so on .

• After the carefully treatment, the woman was told that she can have cesaren section at the 38 week.

• Give you 20 minutes. You can prepare it on your computer and then give the answer to us .

• But there’s a surprise that one question is not about the case.

• 1.What’s the cause of natural abortion?

The causes of natural abortion:

• 1.genetic defect : about 50%~60% of chromosome abnormalities will cause the early abortion.

• 2.maternal factors : • (1).system diseases : such as high fe

ver caused by infection,severe anemia or heart failure,hypertension,chronic nephritis,etc..

• (2).genitalia abnormalities : such as uterus deformity,uterus tumors

• especially submucous myoma.

• and (3).endocrinal abnormalities : hypothyroidism,severe diabetes

• without control & luteal phase defect.

• (4)harmful habits : excessive smoking and drinking,coffee,heroin,etc.

• (5).trauma irritation : shock,operation,anxiety,fear so on

• 3.immune dysfunction : paternal HLA,fetal antigen,ABO&Rh,etc.

• 4.environmental factors : arsenic,lead,benzene,甲醛，氯丁二烯，氧化乙烯 .

• The most probable reason is placanta previa

2.what’s the distinguish point of placenta abruption and placenta previa?

History

• Placenta abruption:• 1.mechanical factors

• 2.sudden loss in uterine and pressure

• 3.vascular case

• Placenta previa:

• A scarred endometrium,curretage multiparity

symptoms

• Vaginal bleeding

• Abdominal pain, back pain, tenderness, anemia

• Spontaneous and recurrent painless, placental vessels sound above pubic symphysis

B-ultrasound

• Placental position

• The relationship between the edge of the placenta and the internal cervical os.

3.How to give oxygen?

How to give oxygen

• Three times each day

• One hour for each time

• Long-time oxygen given may induce the reflective spasm of umbilical vein,aggravating the anoxia of infant heart .

• High pressure and long time oxygen treatment can destroyed infant’s retine

4.What the effects and side effects of sulphuric acid magesium?

Effects and side effects of sulphuric acid magesium

Mechanism:• Mg2+ inhibit the release of Ach from the motor ending, bl

ock the transmission of message in neuro-muscle junction.

• Mg2+ stimulate the synthesis of PGI2 in the endothelium, relax the spasmic state of blood vessels.

• Decrease the [Ca2+] in smooth muscle cells, inhibit the contraction of the uterus.

• Increase the affinity of hemoglobulin to O2 of the mother and the fetal, improve the oxygen metabolism

Side effects:• inhibit the information transmission in the neuro-muscle j

unction: knee reflex disappear, weakness of the limbs, dyspnea, diplopia.

• Inhibit contraction effect and vasodilating effect to the circulatory system: arrhythmia.

• Penetrate the placenta, cause high [Mg2+], low [Ca2+] in fetal blood, impact the muscle tone of the fetal.

Monitoring: knee reflex

5.Why the pregnant women should lie on their left side?

• 1.avoid to press the abdominal aorta,in order to increase to perfusion of uterus

• 2.aviod to prexx the inferior vena cava,in order to increase the output of the heart

• 3.the uterus is right-shift in the late phase of pregnance because of the exist of sigmiod colon,lay on the left side can increase the blood perfusion

6.When should we do the cesaren section?

• criteria for surgery of placenta previa :• 1,complete placenta previa • 2,continuously large amount vaginal bleedi

ng• 3,partial and marginal placenta previa with

large amount bleeding, floating of fetal presentation can not finish delivery in a shot time

• 4,fetal heat rate abnormal

Placenta maturity: 0 <28 immature flat chorinic plate

Ⅰ 39-36

week

tend to mature

fine wave of chorinic plate

Ⅱ 33-40

week

mature concave of chorinic plate, extent to the parenchyma

Ⅲ >38

week

tend to agging

lobular change of placenta

• Ⅱ: indication of cesarean section

• Ⅲ:decreased function, may undergo calcification, harmful to the feta

7.How to count the fetal movement?

quickening

• After menstruation pause 16 to 20 weeks,the pregnant woman feel the fetus’ movement.It’s quickening.

• The quickening is useful to state the safety of fetus. Active quickening suggests fetus’ good situation.

• Quickening do with blood vessel of placenta. If quickening is informal,it’s usually caused by anoxia ,whose mostly effect is quickening down.

Mechanism

• The quickening is caused by fetus’ jump,limb’movement,round and high frequency movement.

• In the lateral pregnancy,fetus’central system could accept the excitement from blood.

• By the fetus acceptor,stimulating sound can cause quickening.

Counting method

• The pregnant woman help self. Three times per day on the bed.

• 30 to 60 minutes one time,then count the frequency of quickening per 12 hours.

• Exam:one hour a time, three times plus.then times 4. The effect is frequency of quickening per 12 hours.

• 16 to 20 weeks after menstruation pause, quickening occurs.It’s mild.

• In the 24th week, 86 times per 12 hours.In the 32th week, 132 times per 12 hours,mostly high frequency.

• Normal value is 30 to 40 times a day. 20 to 30 times is alarming. Less than 20 times is informal.less than 10 times,severe anoxia.

• The more than normal frequency quickening is usually the effect of pressing umbilical cord and placental abruption which cause fetus anoxia.if the symptom could be released,the fetus resume. If accelerate and then ceased,the fetus died.

• When placental dysfunction or fetus have disease, the frequency down.

• If the frequency down and disappear in 1 or2 days, it mostly caused by fetus grow limited,eclampsia,placental dysfunction.

• Thank you !

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