羊水栓塞及子宫破裂.ppt

羊水栓塞AMNIOTIC FLUID EMBOLISM(AFE) 时春艳 Case Presentation(1) 31y, G2P0 Admitted to LD with 40+3 Oxytocin induction C/S for the arresting of the active stage Case Presentation(1) After the baby was delivered Sudden onset: Cough ? dyspnea? mild seizure HR↑(120), ↓BP (70~80/30~50) Postpartum heamorrahage :2200ml Coagulopathy: FIB:1.64, PT14.1’s, Hb 69,BPC:9.2 Case Presentation(1) Diagnosis: Amniotic fluid embolism Treatment: Prognosis: Recovery Case Presentation(2) 26year G2P0 Admitted because of PROM at 5am At 7:am she had uterus constraction At 7:30am she sudden complained of dyspnea and immediately coma Summon for help Case Presentation(3) 36 years old,G3P1 Induction for 41weeks After the baby was delivered by spontaneous vaginally Massive vagina hemoarrhage ↓BP Uterus hysterectomy but die from DIC and multi-organ failure Case Presentation(4) 43 years old Termination of pregnancy because of the fetal abnormality at 33 weeks of gestation Dyspnea before the delivery of the baby BP ,Postpartum Hemorrhage,coma Diagnosis: amniotic fluid embolism DEFINITION 羊水栓塞(amniotic fluid embolism) 在分娩过程中(产程中、产后，最迟产后48h内）突然出 现的: 急性呼吸困难、 休克、循环衰竭、 弥散性血管内凝血(DIC)、 肾功衰竭 或突发死亡的分娩严重并发症。 AFE的认识过程 AFE is thought to occur when amniotic fluid , fetal cells, hair, or other debris enter the maternal circulation. Ricardo Meyer (1926); reported the presence of fetal cellular debris in the maternal pulmonary blood vessel. Steiner and Luschbaugh (1941) described the autopsy findings of eight cases of AFE. Until 1950, only 17 cases had been reported. AFE was not listed as a distinct heading in causes of maternal mortality until 1957 when it was labeled as obstetric shock. Since then more than 400 cases have been documented, probably as a result of an increased awareness. 发生率??  Overall incidence ranges from 1 in 8,000 to 1 in 80,000 pregnancies. The Incidence in our department:1:8000 England:1:56500, American:1:12953 美国3百万分娩的统计显示