妇产科学教学资料_羊水栓塞7年制双语课件.pptVIP

A case, Gravida 3 and Parturition 1,41w, labor induced by propess ，membrane ruptured naturally, at the same time, dyspnea and cyanosis occurred. What happened? If you are the doctor,what should you do? Trachea cannula was done immediately, and CS was prepared. The baby was survival with 9 apgar score. In the operation, sudden cardiac arrest occurred and autonomously heartbeat recovered after 50 minutes external chest compression. But DIC emerged，total hysterectomy was done. Finally, the patient’s life was saved, but she became a vegetable. 羊水栓塞 Amniotic fluid embolism 内 容 概念 (Definition) 病因 (Etiology) 病理生理 （Pathophysiology ) 临床表现 (Clinical manifestation) 诊断 (Diagnosis) 处理（Management) 预防 (Prevention) Definition of AFE AFE is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing cardiorespiratory collapse. epidemiology The incidence of clinically detectable AFE is low estimated to be 1 in 20,000 to 80,000 live births. Maternal mortality approaches 80%. 5%- 10% of maternal mortality in the United States is due to AFE. Of patients with AFE, 50% die within the first hour of onset of symptoms. Of survivors of the initial cardiorespiratory phase, 50% develop a coagulopathy. Neonatal survival is 70%. Current data suggest that the process is more similar to anaphylaxis than to embolism term anaphylactoid syndrome of pregnancy has been suggested 二、病因 (Etiology) Hypertonia of amnion cavity Open blood sinus Injury of cervical canal or uterine wall Placenta previa, placenta abruption, placenta marginal sinus rupture Adherence site of placenta Rupture of membrane 三、病理生理（Pathophysiology ) Anaphylactoid Syndrome Pulmonary hypertension Disseminated intravascular coagulation(DIC) Systemic inflammatory response syndrome (SIRS) 1.心肺功能衰竭和休克 症状：寒战、呛咳、呼吸困难、紫绀、抽搐、昏迷 体征：BP↓、P↑、面色苍白、四肢厥冷、肺底部听诊有湿罗音、心率快弱；病情严重者，仅惊叫一声或打个哈欠后，血压迅速下降，数分钟内死亡 2.出血 难以控制的全身广泛出血 以子宫大出血为主，大量阴道流血 切口渗血 全身皮肤粘膜出血 针眼出血 血