复旦大学上海医学院妇产科学系2009级六年制妇产科学课件 Amniotic Fluid Embolism.ppt

Amniotic Fluid Embolism;Serious intrapartum complication A complex disorder caused by amniotic fluid entering maternal circuration and classically characterized by the abrupt onset of hypotension, hypoxia, and consumptive coagulopathy Incidence: 1:20000 Mortality: 80% in term pregnancy;Rupture of membrane 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 ;Premature rupture of membrane, artificial rupture or stripping of membrane, artificial expansion of cervix Too strong uterine contraction Rigidity contraction and precipitate labour caused by inappropriate using of oxytocin and operation in cavity Injury Cervical laceration, rupture of uterus, uterine incision in caesarean section, forcep curettage ;Some pathological pregnancy Twin, multiplets, macrosomia, polyhydramnions, prolonged labour, dystocia, placenta abruption, placenta previa, retention of dead fetus, infection of amnion cavity, fetal distress Press abdoman and uterus by brute force ;Internal cervical vein Amniotic fluid volume entering maternal circulation related to : strength of contraction degree of injury Uterine placenta bed ： Broken venule in adherence site of placenta Fissure in adherence site of placenta Open decidua blood sinus placenta marginal vessel Amniotic permeation?pressure of amniotic cavity↑?intensity of amniotic membrane ↓;Pathyphysiology ;Amniotic fluid (Epithelial cell, mucus,meconium, vernix caseosa, lanugo); ;Premonitory symptom： Short-period dysphoria, chill and shiver, cough and dyspnea, cyanosis, vomit at the time of rupture of membrane Symptoms disappear after treatment in mild AFE, severe AFE arise three stages : Respiratory and circulatory failure, shork Bleeding caused by DIC Acute renal failure ;Acute respiratory and circulatory failure Obvious cyanosis Dyspnea