羊水栓塞与子宫破裂推荐.ppt

Restoration of uterine tone Uterine atony is best treated with massage, uterine packing, and oxytocin or prostaglandin analogues. Hysterectomy may be necessary Improvement in cardiac output and uterine perfusion helps restore uterine tone. Extreme care should be exercised when using prostaglandin analogues in hypoxic patients, as bronchospasm may worsen the situation. * Sympathomimetic Vasopressor agentDopamine Dopamine increases myocardial contractility and systolic BP with little increase in diastolic BP. Also dilates the renal vasculature, increasing renal blood flow and GFR. DOSE: 2-5 mcg/kg/min IV; titrate to BP and cardiac output. Contraindications: ventricular fibrillation, hypovolemia, pheochromocytoma. Precautions: Monitor urine flow, cardiac output, pulmonary wedge pressure, and BP during infusion; prior to infusion, correct hypovolemia with either whole blood or plasma, as indicated; monitoring central venous pressure or left ventricular filling pressure may be helpful * Maternal Mortality in AFE Maternal death usually occurs in one of three ways: (1) sudden cardiac arrest, (2) hemorrhage due to coagulopathy, or (3) initial survival with death due to acute respiratory distress syndrome (ARDS) and multiple organ failure For women diagnosed as having AFE, mortality rates ranging from 26% to as high as 86% have been reported. The variance in these numbers is explained by dissimilar case definitions and possibly improvements in intensive care management of affected patients. * Further issues in the Management Transfer: Transfer to a level 3 hospital may be required once the patient is stable. Prevention: Amniotic fluid embolism is an unpredictable event. Risk of recurrence is unknown. The recommendation for elective cesarean delivery during future pregnancies in an attempt to avoid labor is controversial. P