産科 / 救急

常位胎盤早期剥離 — 管理パス

性器出血+腹痛+胎児心拍異常。臨床診断が主。母体蘇生と緊急娩出の判断。

根拠：ACOG / Merck。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。

ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。

ステップ 1 · Maternal-fetal status & gestational age
Maternal-fetal status and gestational age?
💡 Premature placental separation at >20 weeks: vaginal bleeding + abdominal pain/uterine tenderness ± contractions + abnormal fetal heart rate; bleeding can be concealed → hemorrhagic shock/DIC/fetal distress and death. Clinical diagnosis (ultrasound is insensitive, normal does not exclude); check coagulation (DIC — fibrinogen may be normal initially, monitor serially), cross-match, fetal monitoring, Kleihauer/anti-D if Rh-negative. Resuscitate and monitor serially in all preterm/suspected cases.

パス全体像

  1. 【判断】Maternal-fetal status & gestational age
    Maternal-fetal status and gestational age?（Premature placental separation at >20 weeks: vaginal bleeding + abdominal pain/uterine tenderness ± contractions + abnormal fetal heart rate; bleeding can be concealed → hemorrhagic shock/DIC/fetal distress and death. Clinical diagnosis (ultrasound is insensitive, normal does not exclude); check coagulation (DIC — fibrinogen may be normal initially, monitor serially), cross-match, fetal monitoring, Kleihauer/anti-D if Rh-negative. Resuscitate and monitor serially in all preterm/suspected cases.）
    • Mother unstable / fetal distress / term → Unstable → deliver promptly
    • Maternal-fetal stable, preterm → Stable preterm · expectant
  2. 【終点】Stable preterm · expectant
    Maternal-fetal stable, preterm, 軽症 abruption: expectant management — 入院に対し密な監視 (continuous fetal heart rate, 出血, coagulation, vital signs); ステロイドに対しfetal lung maturity; anti-Dの場合Rh-negative; cross-match. Bleeding worsening/abnormal fetal heart rate/worsening coagulation → deliver 直ちに.
  3. 【終点】Unstable → deliver promptly
    Mother unstable / fetal distress / term: deliver promptly — emergency 帝王切開の場合the 胎児 is viable・distressed; 経腟分娩の場合the 胎児 has diedまたはlabor is established・the 母体 is stable. Concurrently resuscitate: large-bore IV, transfuse productsへcorrect blood loss・DIC (PRBC/FFP/cryoprecipitate/血小板s/fibrinogen), monitor coagulation serially (DIC may be delayed); anti-Dの場合Rh-negative.

よくある質問

常位胎盤早期剥離 — 管理パスはどの臨床課題を扱う診療パスですか？
性器出血+腹痛+胎児心拍異常。臨床診断が主。母体蘇生と緊急娩出の判断。
常位胎盤早期剥離 — 管理パスの主要な意思決定ステップは何ですか？
Maternal-fetal status & gestational age
常位胎盤早期剥離 — 管理パスはどのような対応方針を示しますか？
Stable preterm · expectant：Maternal-fetal stable, preterm, 軽症 abruption: expectant management — 入院に対し密な監視 (continuous fetal heart rate, 出血, coagulation, vital signs); ステロイドに対しfetal lung maturity; anti-Dの場合Rh-negative; cross-match. Bleeding worsening/abnormal fetal heart rate/worsening coagulation → deliver 直ちに.；Unstable → deliver promptly：Mother unstable / fetal distress / term: deliver promptly — emergency 帝王切開の場合the 胎児 is viable・distressed; 経腟分娩の場合the 胎児 has diedまたはlabor is established・the 母体 is stable. Concurrently resuscitate: large-bore IV, transfuse productsへcorrect blood loss・DIC (PRBC/FFP/cryoprecipitate/血小板s/fibrinogen), monitor coagulation serially (DIC may be delayed); anti-Dの場合R…
常位胎盤早期剥離 — 管理パスのうち直ちに対応が必要な状況はどれですか？
Unstable → deliver promptly：Mother unstable / fetal distress / term: deliver promptly — emergency 帝王切開の場合the 胎児 is viable・distressed; 経腟分娩の場合the 胎児 has diedまたはlabor is established・the 母体 is stable. Concurrently resuscitate: large-bore IV, transfuse productsへcorrect blood loss・DIC (PRBC/FFP/cryoprecipitate/血小板s/fibrinogen), monitor coagulation serially (DIC may be delayed); anti-Dの場合Rh-negative.
常位胎盤早期剥離 — 管理パスはどのガイドラインに基づいていますか？
ACOG antepartum hemorrhage; Merck placental abruption · 準拠：ACOG / Merck

出典

  • ACOG antepartum hemorrhage; Merck placental abruption

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