上海交通大学医学院：《妇产科学》（双语） 49 Amniotic fluid embolism

Amniotic fluid embolism (AFEy 羊水栓塞

Amniotic Fluid Embolism (AFE) 羊水栓塞

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

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 a The incidence of clinically detectable AFE is low estimated to be 1 in 20.000 to 80.000 live births Maternal mortality approaches 80%0 5%0-10% 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%o

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%

a Current data suggest that the process is more similar to anaphylaxis than to embolism term anaphylactoid syndrome of pregnancy has been suggested

◼ Current data suggest that the process is more similar to anaphylaxis than to embolism ◼ term anaphylactoid syndrome of pregnancy has been suggested

Major causes and factors occurs in obstetric terms or during labor multiparous woman with a large baby a short tumultuous labor use of uterine stimulants occurred during abortion amnioinfusion ■ Amniocentesis caesarian section a placenta accreta ■ ruptured uterus

Major causes and factors ◼ occurs in obstetric terms or during labor ◼ multiparous woman with a large baby ◼ a short tumultuous labor ◼ use of uterine stimulants ◼ occurred during abortion ◼ amnioinfusion ◼ Amniocentesis ◼ caesarian section ◼ placenta accreta ◼ ruptured uterus

pathology Amniotic fluid and fetal cells enter the maternal circulation, possibly triggering an anaphylactic reaction to fetal antigens a(1) Clinical symptoms result from mast cell degranulation with the release of histamine and tryptase, (2) Clinical symptoms result from activation of the complement pathway

pathology ◼ Amniotic fluid and fetal cells enter the maternal circulation, possibly triggering an anaphylactic reaction to fetal antigens. ◼ (1) Clinical symptoms result from mast cell degranulation with the release of histamine and tryptase, ◼ (2) Clinical symptoms result from activation of the complement pathway

Progression usually occurs in 2 phases hase a pulmonary artery vasospasm with pulmonary hypertension and elevated right ventricular pressure cause hypoxia Hypoxia causes myocardial capillary damage and pulmonary capillary damage, eft heart failure, and acute respiratory distress syndrome

◼ . Progression usually occurs in 2 phases. ◼ phase I: ◼ pulmonary artery vasospasm with pulmonary hypertension and elevated right ventricular pressure cause hypoxia. ◼ Hypoxia causes myocardial capillary damage and pulmonary capillary damage, left heart failure, and acute respiratory distress syndrome. ◼

Women who survive these events may enter phase ll a This is a hemorrhagic phase characterized by massive hemorrhage with uterine atony and DIC however, fatal consumptive coagulopathy may be the initial presentation

◼ Women who survive these events may enter phase II. ◼ This is a hemorrhagic phase characterized by massive hemorrhage with uterine atony and DIC ◼ however, fatal consumptive coagulopathy may be the initial presentation

Presentation The clinical presentation of AFE is generally dramatic a in the late stages acutely dyspnea and ypotension with rapid progression to cardiopulmonary arrest a In 40% of cases, followed by some degree of consumptive coagulopathy

Presentation ◼ The clinical presentation of AFE is generally dramatic ◼ in the late stages , acutely dyspnea and hypotension with rapid progression to cardiopulmonary arrest ◼ In 40% of cases, followed by some degree of consumptive coagulopathy

a Hypotension: Blood pressure may drop significantly with loss of diastolic measurement Dyspnea: Labored breathing and tachypnea may occur. Seizure: The patient may experience tonic-clonic seizures。 Cough: This is usually a manifestation of dyspnea. Cyanosis: As hypoxia/hypoxemia progresses, circumoral and peripheral cyanosis and changes in mucous membranes may manifest

◼ Hypotension: Blood pressure may drop significantly with loss of diastolic measurement. ◼ Dyspnea: Labored breathing and tachypnea may occur. ◼ Seizure: The patient may experience tonic-clonic seizures. ◼ Cough: This is usually a manifestation of dyspnea. ◼ Cyanosis: As hypoxia/hypoxemia progresses, circumoral and peripheral cyanosis and changes in mucous membranes may manifest