Early warning of severe postpartum hemorrhage

doi:10.3877/cma.j.issn.1673-5250.2016.05.001

Postpartum hemorrhage (PPH) is the leading cause of maternal death, and most of the maternal deaths caused by PPH are preventable. It is crucial to recognize the severity of PPH early and give prompt treatment to reduce the maternal mortality rate. The early warning methods of severe PPH and maternal early warning trigger (MEAT) are reviewed in this article, in order to provide some guidance for obstetricians.

Key words: Severe postpartum hemorrhage, Early warning, Maternal mortality, Maternal early warning trigger, Pregnant women

表1 低血容量休克的临床症状和体征及其病因分析

临床症状和体征		病因
心动过速		儿茶酚胺释放→心排血量↑、外周血管收缩→维持重要脏器灌注
血压降低		血容量降低
呼吸增快		严重失血→血氧含量↓→反射性呼吸增快→维持血氧含量，呼吸增快，也可能是由代谢性酸中毒引起的
体温降低		外周血管收缩，快速补充常温液体
脉搏血氧饱和度		由于外周血管明显收缩，此时脉搏血氧饱和度往往不能准确反映组织氧供
意识改变		?
?	焦虑、烦躁不安	中枢神经系统血流灌注不足
?	意识模糊和减退	?
皮肤苍白、四肢冰凉		外周血管收缩
口干和黏膜干燥		大量液体丢失→脱水
少尿		肾脏血流灌注不足

表1 低血容量休克的临床症状和体征及其病因分析

临床症状和体征		病因
心动过速		儿茶酚胺释放→心排血量↑、外周血管收缩→维持重要脏器灌注
血压降低		血容量降低
呼吸增快		严重失血→血氧含量↓→反射性呼吸增快→维持血氧含量，呼吸增快，也可能是由代谢性酸中毒引起的
体温降低		外周血管收缩，快速补充常温液体
脉搏血氧饱和度		由于外周血管明显收缩，此时脉搏血氧饱和度往往不能准确反映组织氧供
意识改变		?
?	焦虑、烦躁不安	中枢神经系统血流灌注不足
?	意识模糊和减退	?
皮肤苍白、四肢冰凉		外周血管收缩
口干和黏膜干燥		大量液体丢失→脱水
少尿		肾脏血流灌注不足

表2 产后失血性休克的临床分期(基于失血量)

严重程度	临床表现	失血比例(%)	累计失血量(mL)
无休克	无临床症状	<20	<900
轻度	心动过速(<100次/min)，血压轻度降低，外周血管收缩	20～25	1 200～1 500
中度	心动过速(100～120次/min)，低血压(80～100 mmHg)，烦躁不安，少尿	30～35	1 800～2 100
重度	心动过速(≥120次/min)，低血压(<60 mmHg)，意识改变，无尿	≥35	≥2 400

表2 产后失血性休克的临床分期(基于失血量)

严重程度	临床表现	失血比例(%)	累计失血量(mL)
无休克	无临床症状	<20	<900
轻度	心动过速(<100次/min)，血压轻度降低，外周血管收缩	20～25	1 200～1 500
中度	心动过速(100～120次/min)，低血压(80～100 mmHg)，烦躁不安，少尿	30～35	1 800～2 100
重度	心动过速(≥120次/min)，低血压(<60 mmHg)，意识改变，无尿	≥35	≥2 400

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