1、羊水栓塞和子宫破裂羊水栓塞和子宫破裂羊水栓塞和子宫破裂2羊水栓塞和子宫破裂3羊水栓塞和子宫破裂4羊水栓塞和子宫破裂5羊水栓塞和子宫破裂6羊水栓塞和子宫破裂7羊水栓塞和子宫破裂8羊水栓塞和子宫破裂9 羊水栓塞和子宫破裂10羊水栓塞和子宫破裂11羊水栓塞和子宫破裂12Nevertheless,these and other frequently cited risk factors are not consistently observed and at the present time Experts agree that this condition is not preventable.羊水
2、栓塞和子宫破裂13羊水栓塞和子宫破裂14羊水栓塞和子宫破裂15羊水栓塞和子宫破裂16羊水栓塞和子宫破裂17羊水栓塞和子宫破裂18羊水栓塞和子宫破裂19羊水栓塞和子宫破裂20羊水栓塞和子宫破裂21羊水栓塞和子宫破裂22羊水栓塞和子宫破裂23羊水栓塞和子宫破裂24羊水栓塞和子宫破裂25羊水栓塞和子宫破裂26羊水栓塞和子宫破裂27羊水栓塞和子宫破裂28羊水栓塞和子宫破裂29Management of AFE Coagulopathy DIC results in the depletion of fibrinogen,platelets,and coagulation factors,especia
3、lly factors V,VIII,and XIII.The fibrinolytic system is activated as well.Most patients will have hypofibrinogenemia,abnormal PT and aPTT and low Platelet counts fibrinogen level，补充纤维蛋白原和血小板，补充纤维蛋白原和血小板羊水栓塞和子宫破裂30羊水栓塞和子宫破裂31Sympathomimetic Vasopressor agentDopamineDopamine increases myocardial contra
4、ctility and systolic BP with little increase in diastolic BP.Also dilates the renal vasculature,increasing renal blood flow and GFR.DOSE:2-5 mcg/kg/min IV;titrate to BP and cardiac output.Contraindications:ventricular fibrillation,hypovolemia,pheochromocytoma.Precautions:Monitor urine flow,cardiac o
5、utput,pulmonary wedge pressure,and BP during infusion;prior to infusion,correct hypovolemia with either whole blood or plasma,as indicated;monitoring central venous pressure or left ventricular filling pressure may be helpful羊水栓塞和子宫破裂32羊水栓塞和子宫破裂34Medical/Legal Pitfalls Failure to respond emergently
6、is a pitfall.AFE is a clinical diagnosis.Steps must be taken to stabilize the patient as soon as symptoms manifest.Failure to perform perimortem cesarean delivery in a timely fashion is a pitfall.Failure to consider the diagnosis during legal abortion is a pitfall.A review of the literature indicate
7、s that most case reports of AFE have occurred during late second-trimester abortions.羊水栓塞和子宫破裂35SUMMARY AFE is a sudden and unexpected rare but life threatening complication of pregnancy.It has a complex pathogenesis and serious implications for both mother and infant.Associated with high rates of m
8、ortality and morbidity.Diagnosis of exclusion.Suspect AFE when confronted with any pregnant patient who has sudden onset of respiratory distress,cardiac collapse,seizures,unexplained fetal distress,and abnormal bleeding Obstetricians should be alert to the symptoms of AFE and strive for prompt and aggressive treatment.羊水栓塞和子宫破裂36羊水栓塞和子宫破裂38羊水栓塞和子宫破裂39羊水栓塞和子宫破裂40羊水栓塞和子宫破裂41羊水栓塞和子宫破裂42羊水栓塞和子宫破裂43羊水栓塞和子宫破裂44羊水栓塞和子宫破裂45羊水栓塞和子宫破裂46羊水栓塞和子宫破裂47羊水栓塞和子宫破裂48
