How to prevent postpartum amniotic fluid embolism?

summary

In the process of fetal delivery, if amniotic fluid enters the maternal blood circulation, it can cause a series of serious symptoms such as pulmonary embolism, shock and disseminated intravascular coagulation, which is called amniotic fluid embolism. It is rare in clinic, but the mortality is high. Most of the causes are uterine contraction or ankylosis, high intrauterine pressure, amniotic fluid from the lacerated cervical vein into the maternal blood circulation shortly after rupture or rupture of the fetal membrane. Let's share my experience with you.

How to prevent postpartum amniotic fluid embolism?

Respiratory and circulatory failure: according to the disease is divided into two types of violent and slow. After the prodromal symptoms, dyspnea and cyanosis appeared quickly. Acute pulmonary edema has cough, spitting phlegm, rapid heart rate, blood pressure drop or even disappear. A few cases died of sudden cardiac arrest after only one scream. Slow type of respiratory and circulatory symptoms are mild, or even no obvious symptoms, until postpartum bleeding, blood coagulation was found.

Systemic bleeding tendency: some patients with amniotic fluid embolism were rescued through the period of respiratory and circulatory failure, and then DIC occurred. The bleeding tendency of the whole body was mainly vaginal bleeding, such as mucous membrane, skin, needle eye bleeding and hematuria. It is worth noting that some cases of amniotic fluid embolism, lack of respiratory and circulatory symptoms, the onset of the disease is difficult to control postpartum vaginal bleeding as the main performance, must not be simply mistaken for uterine atony caused postpartum hemorrhage.

Multiple system organ injury: all organs of the body are damaged, except the heart, the kidney is the most frequently damaged organ. Due to renal hypoxia, there are oliguria, urinary incontinence, hematuria and azotemia, which can lead to death due to renal failure; When the brain is short of oxygen, the patient can have irritability, convulsion and coma.

matters needing attention

Prevention of heart failure: rapid digitalis preparation, 0.2-0.4mg of desacetyl lanolin (cedilanid) diluted in 20ml of 25% glucose solution, intravenous injection, repeated 4-6 hours if necessary, the total amount is less than 1.2mg per day. In addition, furosemide 40-80 mg, intravenous injection, prevention and treatment of heart failure, to improve the success rate of rescue is of great significance.