羊水栓塞与子宫破裂

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1、羊水栓塞AMNIOTICFLUIDEMBOLISM(AFE)时春艳CasePresentation(1)31y,G2P0AdmittedtoL&Dwith40+3OxytocininductionC/SforthearrestingoftheactivestageCasePresentation(1)AfterthebabywasdeliveredSuddenonset:CoughdyspneamildseizureHR↑(120),↓BP(70~80/30~50)Postpartumheamorrahage:2

2、200mlCoagulopathy:FIB:1.64,PT14.1’s,Hb69,BPC:9.2CasePresentation(1)Diagnosis:AmnioticfluidembolismTreatment:Prognosis:RecoveryCasePresentation(2)26yearG2P0AdmittedbecauseofPROMat5amAt7:amshehaduterusconstractionAt7:30amshesuddencomplainedofdyspneaandimmediatelyc

3、omaSummonforhelpCasePresentation(3)36yearsold,G3P1Inductionfor41weeksAfterthebabywasdeliveredbyspontaneousvaginallyMassivevaginahemoarrhage↓BPUterushysterectomybutdiefromDICandmulti-organfailureCasePresentation(4)43yearsoldTerminationofpregnancybecauseofthefetal

4、abnormalityat33weeksofgestationDyspneabeforethedeliveryofthebabyBP,PostpartumHemorrhage,comaDiagnosis:amnioticfluidembolismDEFINITION羊水栓塞(amnioticfluidembolism)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AFEisthoughttooccu

5、rwhenamnioticfluid,fetalcells,hair,orotherdebrisenterthematernalcirculation.RicardoMeyer(1926);reportedthepresenceoffetalcellulardebrisinthematernalpulmonarybloodvessel.SteinerandLuschbaugh(1941)describedtheautopsyfindingsofeightcasesofAFE.Until1950,only17casesh

6、adbeenreported.AFEwasnotlistedasadistinctheadingincausesofmaternalmortalityuntil1957whenitwaslabeledasobstetricshock.Sincethenmorethan400caseshavebeendocumented,probablyasaresultofanincreasedawareness.发生率Overallincidencerangesfrom1in8,000to1in80,000pregnancies.T

7、heIncidenceinourdepartment:1:8000England:1:56500,American:1:12953美国3百万分娩的统计显示7.7/10万14%ofmaternaldeathsinUSA(第二位的死亡原因)&5.3%inU.K.美国的孕产妇死亡率6.6/10万我国统计?第二或第三位的原因Thefirstwell-documentedcasewithultimatesurvivalwaspublishedin1976(ResnikR,etal.ObstetGynecol1976;47:295

8、-8).Maternalfatalityrate:13~30%61%~86%before199475%ofsurvivorsareexpectedtohavelong-termneurologicdeficits.Perinatalmortality:9~44%Ifthefetusisaliveatthetimeoftheeven