妇产科学 18 羊水栓塞AFE学习资料.ppt

XiaYinM.D.Ph.DObstetricsGynecologyRen-JiHospital羊水栓塞

AmnioticFluidEmbolism(AFE)

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DefinitionAFEisarareobstetricemergencyinwhichamnioticfluid,fetalcells,hair,orotherdebrisenterthematernalcirculation,causingcardiorespiratorycollapse.pulmonaryembolismallergicshockdisseminatedinravascularcoagulation,DICrenalfailure

EpidemiologyTheincidenceofclinicallydetectableAFEislowestimated1in20,000to80,000livebirths.Maternalmortality80%.Neonatalsurvivalis70%.5%-10%ofmaternalmortalityinUSAisduetoAFE.50%diewithinthefirsthourofonsetofsymptoms.Ofsurvivorsoftheinitialcardiorespiratoryphase,50%developacoagulopathy.

CurrentdatasuggestthatAFEismoresimilartoanaphylaxisthantoembolism“anaphylactoidsyndromeofpregnancy”

MajorcausesandfactorsoccursinobstetrictermsorduringlabormultiparouswomanwithalargebabyashorttumultuouslaboruseofuterinestimulantsoccurredduringabortionamnioinfusionAmniocentesiscaesariansectionplacentaaccretaruptureduterus

PathologyAmnioticfluidandfetalcellsenterthematernalcirculation,possiblytriggeringananaphylacticreactiontofetalantigens.(1)mastcelldegranulationwiththereleaseofhistamineandtryptase,(2)activationofthecomplementpathway.Progressionusuallyoccursin2phases.

PhaseIpulmonaryarteryvasospasmwithpulmonaryhypertensionandelevatedrightventricularpressurecausehypoxia.Hypoxiacausesmyocardialcapillarydamageandpulmonarycapillarydamage,leftheartfailure,andacuterespiratorydistresssyndrome.

Physiopathologypulmonaryarteryvasospasmamnioticfluid,fetalcell,debrisanaphylaxispulmonaryhypertensionelevatedrightventricularpressurehypoxia.myocardialcapillarydamageleftheartfailureacuterespiratorydistresssyndrome.pulmonarycapillarydamage

PhaseII.Thisisahemorrhagicphasecharacterizedbymassivehemorrhagewithuterineat