羊水栓塞与子宫破裂PPT格式课件下载.ppt

羊水栓塞与子宫破裂PPT格式课件下载.ppt

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2200ml:

2200mlllCoagulopathyCoagulopathy:

FIB:

1.64,PT14.1s,:

1.64,PT14.1s,HbHb69,BPC:

9.269,BPC:

9.2CasePresentation

（1）llDiagnosis:

AmnioticfluidembolismllTreatment:

llPrognosis:

RecoveryCasePresentation

（2）ll26yearG2P0llAdmittedbecauseofPROMat5amllAt7:

amshehaduterusconstractionllAt7:

30amshesuddencomplainedofdyspneaandimmediatelycomallSummonforhelpCasePresentation（3）ll36yearsold,G3P136yearsold,G3P1llInductionfor41weeksInductionfor41weeksllAfterthebabywasdeliveredbyAfterthebabywasdeliveredbyspontaneousvaginallyspontaneousvaginallyllMassivevaginaMassivevaginahemoarrhagehemoarrhagellBPBPllUterushysterectomybutdiefromDICandUterushysterectomybutdiefromDICandmulti-organfailuremulti-organfailureCasePresentation（4）ll43yearsoldllTerminationofpregnancybecauseofthefetalabnormalityat33weeksofgestationllDyspneabeforethedeliveryofthebabyllBP,PostpartumHemorrhage,comallDiagnosis:

amnioticfluidembolismDEFINITIONll羊水栓塞羊水栓塞羊水栓塞羊水栓塞（amnioticfluidembolism）（amnioticfluidembolism）在分娩过程中在分娩过程中在分娩过程中在分娩过程中（产程中、产后，最迟产后产程中、产后，最迟产后产程中、产后，最迟产后产程中、产后，最迟产后48h48h内）突然出内）突然出内）突然出内）突然出现的现的现的现的:

急性呼吸困难、急性呼吸困难、急性呼吸困难、急性呼吸困难、休克、循环衰竭、休克、循环衰竭、休克、循环衰竭、休克、循环衰竭、弥散性血管内凝血弥散性血管内凝血弥散性血管内凝血弥散性血管内凝血（DIC）（DIC）、肾功衰竭肾功衰竭肾功衰竭肾功衰竭或突发死亡的分娩严重并发症。

或突发死亡的分娩严重并发症。

AFE的认识过程llAFEisthoughttooccurwhenamnioticfluid,fetalcells,hair,orAFEisthoughttooccurwhenamnioticfluid,fetalcells,hair,orotherdebrisenterthematernalcirculation.otherdebrisenterthematernalcirculation.llRicardoMeyer（1926）;

reportedthepresenceoffetalcellularRicardoMeyer（1926）;

reportedthepresenceoffetalcellulardebrisinthematernalpulmonarybloodvessel.debrisinthematernalpulmonarybloodvessel.llSteinerandSteinerandLuschbaughLuschbaugh（1941）describedtheautopsyfindings（1941）describedtheautopsyfindingsofeightcasesofAFE.ofeightcasesofAFE.llUntil1950,only17caseshadbeenreported.Until1950,only17caseshadbeenreported.llAFEwasnotlistedasadistinctheadingincausesofmaternalAFEwasnotlistedasadistinctheadingincausesofmaternalmortalityuntil1957whenitwaslabeledasobstetricshock.mortalityuntil1957whenitwaslabeledasobstetricshock.llSincethenmorethan400caseshavebeendocumented,Sincethenmorethan400caseshavebeendocumented,probablyasaresultofanincreasedawareness.probablyasaresultofanincreasedawareness.发生率llOverallincidencerangesfrom1in8,000to1in80,000Overallincidencerangesfrom1in8,000to1in80,000pregnancies.pregnancies.TheIncidenceinourdepartment:

1:

8000TheIncidenceinourdepartment:

8000England:

56500,American:

12953England:

12953美国美国美国美国33百万分娩的百万分娩的百万分娩的百万分娩的统计显统计显示示示示7.7/107.7/10万万万万ll14%ofmaternaldeathsinUSA（14%ofmaternaldeathsinUSA（第二位的死亡原因第二位的死亡原因第二位的死亡原因第二位的死亡原因）&

5.3%inU.K.&

5.3%inU.K.美国的孕产妇死亡率美国的孕产妇死亡率美国的孕产妇死亡率美国的孕产妇死亡率6.6/106.6/10万万万万我国统计我国统计我国统计我国统计?

第二或第三位的原因第二或第三位的原因第二或第三位的原因第二或第三位的原因llThefirstwell-documentedcasewithultimatesurvivalThefirstwell-documentedcasewithultimatesurvivalwaspublishedin1976waspublishedin1976（ResnikResnikR,etal.R,etal.ObstetObstetGynecolGynecol1976;

47:

295-8）.1976;

295-8）.llMaternalfatalityrate:

1330%Maternalfatalityrate:

1330%61%86%before199461%86%before199475%ofsurvivorsareexpectedtohavelong-termneurologic75%ofsurvivorsareexpectedtohavelong-termneurologicdeficits.deficits.llPerinatalPerinatalmortality:

944%mortality:

944%Ifthefetusisaliveatthetimeoftheevent,nearly70%willIfthefetusisaliveatthetimeoftheevent,nearly70%willsurvivethedeliverybut50%ofthesurvivedneonateswillincursurvivethedeliverybut50%ofthesurvivedneonateswillincurneurologicdamage.neurologicdamage.AMNIOTICFLUIDEMBOLISMllTimeofevent:

-Duringlabor.-DuringC/S.-Afternormalvaginaldelivery.-DuringsecondtrimesterTOP.llAFEsyndromehasbeenreportedtooccuraslateas48hoursfollowingdelivery.RiskfactorsofAFEllAdvancedmaternalageAdvancedmaternalagellMultiparityMultiparityllMeconiumMeconiumllCervicallacerationCervicallacerationllVerystrongfrequentorVerystrongfrequentoruterineuterinetetanictetaniccontractionscontractionsllSuddenSuddenfoetalfoetalexpulsionexpulsion（short（shortlabourlabour）llPlacentaabnormalityPlacentaabnormalityllPolyhydramniosPolyhydramniosllUterineruptureUterinerupturellMaternalhistoryofallergyorMaternalhistoryofallergyoratopyatopyllChorioamnionitisChorioamnionitisllMacrosomiaMacrosom