妇产科学-Amniotic Fluid Embolism.ppt

Amniotic Fluid Embolism Department of gynecology and obstetrics of Zhongshan hospital Fudan university Definition Amniotic Fluid Embolism is a complex disorder during labor characterized by amniotic fluid entering into the maternal circulation which causes acute pulmonary embolism, shock, DIC, acute renal failure or abrupt death. overview An devastating complication during labor Mortality: up to 70%~80% May occur in the first and second trimester abortions Recently, it is also termed “anaphylactoid syndrome of pregnancy” Why amniotic fluid can enter into the maternal circulation? Three factors Disruption of fetal membrane Greater intensity of uterine contractions Breaching blood vessel Pathogenisis There is a breach in vein or blood sinus at the trauma site of cervix and the body of uterine Higher pressure of amniotic cavity After disruption of fetal membrane, amniotic fluid enters into the maternal circulation through the breached vein and blood sinus Main reason: greater contraction and high pressure of amniotic cavity Common clinic causative factor Greater contraction → rupture of fetal membrane Fetal membrane separate from cervical wall Pathologic blood sinus breach: cervical laceration, rupture of uterus, placenta previa, placental abruption or caesarean section Amniocentesis and curettage or scraping pathophysiology Pulmonary artery hypertention Allergic shock DIC Acute renal failure(ARF) Clinical presentation Acute amniotic fluid embolism: occur acutely Diagnosis According to the typical clinic manifestation, we can make the preliminary diagnosis and salve the patients immediately While salving the patients do the necessary auxiliary examination, including: Basis of laboratory examination for DIC PLT＜ 100 ╳109/L or it was gradually decrease fibrinogen 1.5g/L PT 15 s plasm protamine paracoagulation test (+) CT 30 minites Obtrite RBC in blood smear Management Improve hypoxia Anti-anaphylacic shock Prevent DIC and acute rena