羊水栓塞处理方案.docx

AFE （1）Risk factors for amniotic fluid embolism Fetal factorsMaternal factorsObstetrical factorsMale genderAdvanced maternal age 35Cesarean sectionPlacenta previaMultiparityCervical lacerationPlacenta accretaDiabetesInduction of laborPlacental abruptionInstrumental delivery: forceps and vacuum-assisted vaginal deliveriesFetal distressUterine rupturePolyhydramniosEclampsiaFetal macrosomiaOxytocin usePremature rupture of membranesIntrauterine death （2）Pathophysiology of amniotic fluid embolism （3）Classification of AFE. Amniotic fluid embolism can be classified as (1) the mechanical obstruction subtype, (2) the anaphylactic subtype, and (3) the DIC subtype. This subclassificationmay be beneficial in the diagnosis and the personalized treatment of AFE. (4)Proposed clinical phases of amniotic fluid embolism （5）Clinical manifestations of amniotic fluid embolism （6）diagnostic criteria（UK obstetric surveillance system） Either - In the absence of any other clear cause Acute maternal collapse with one or more of the following Acute fetal compromise Cardiac arrest Cardiac arrhythmias Hypotension Maternal hemorrhage Coagulopathy Premonitory symptoms Seizure Shortness of breath Excluding women with maternal hemorrhage as the first presenting feature in whom there was no evidence of early coagulopathy or cardio-respiratory compromise Or Women in whom the diagnosis was made at postmortem examination with fetal squames or hair in the lungs （7）Adjuvant laboratory tests in amniotic fluid embolism Complete blood counts Peripheral smear Coagulation profile - PT, aPTT, D-dimer, fibrin degradation products, fibrinogen Thromboelastography/thromboelastometry Serum electrolytes ABG ECG Cardiac enzymes Echocardiography (transthoracic/transesophageal) Chest radiograph （8）Differential diagnoses of AFE Respiratory Pulmonary embolism Air embolism Aspiration Tension pneumothorax Aspiration Pulmonary edema Cardiac Acute myocardial infarction Peripartum card