糖尿病对母儿的影响

Condition of AFE Onset
Rupture of membrane Hypertonia of amnion cavity Open blood sinus
Injury of cervical canal or uterine wall Placenta previa, placenta abruption, placenta
circuration and classically characterized by the abrupt onset of hypotension, hypoxia, and consumptive coagulopathy Incidence: 1:20000 Mortality: 80% in term pregnancy
Amniotic Fluid Embolism
1
Amniotic Fluid Embolism(AFE)
Serious intrapartum complication A complex disorder caused by amniotic fluid entering maternal
Uterine placenta bed ：
Broken venule in adherence site of placenta Fissure in adherence site of placenta Open decidua blood sinus
placenta marginal vessel Amniotic permeationpressure of amniotic
marginal sinus rupture Adherence site of placenta
Predisposing factors
Premature rupture of membrane, artificial rupture or stripping of membrane, artificial expansion of cervix
Respiratory anoxia, (cyanosis) acidosis Anxious, Metabolic
anoxia Acute
seizure, acidosis renal
coma
failure
Bp drop
shork
Clinical manifestation
Abrupt onset , critical oncoming force
Amniotic fluid (Epithelial cell, mucus,meconium, vernix caseosa, lanugo)
Ⅰallergic reaction
Maternal circulation
reflectively
pulmonary
circulation
Vessel embolism Vessel spasm bronchospasm bronchi secretion
chill Vessel block ，stenosis bronchiostenosis increased
Bleeding without coagulation
Pulmonary hypertention ventilation obstruct
toxicosis and anoxia
returned blood Acute
Acute respiratory
of the whole body
volume to LA pulmonary
failure
output
heart disease
cerebral Histanoxia renal
Peripheral circulatory failure,
Right heart failure
Too strong uterine contraction
Rigidity contraction and precipitate labour caused by inappropriate using of oxytocin and operation in cavity
Injury
Press abdoman and uterus by brute force
Pathway of amnion fluid entering maternal blood circulation
Internal cervical vein
Amniotic fluid volume entering maternal circulation related to : strength of contraction degree of injury
cavity↑intensity of amniotic membrane ↓
Pathyphysiology
Pulmonary hypertensiห้องสมุดไป่ตู้n Allergic shork Disseminated intravascular coagulation(DIC) Acute renal failure
Cervical laceration, rupture of uterus, uterine incision in caesarean section, forcep curettage
Some pathological pregnancy
Twin, multiplets, macrosomia, polyhydramnions, prolonged labour, dystocia, placenta abruption, placenta previa, retention of dead fetus, infection of amnion cavity, fetal distress
﹣ Three stages appear in sequence in typical cases ﹣ Only mass vaginal bleeding and shork in atypical cases