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分娩第一阶段肺栓塞与羊水栓塞的鉴别诊断——一例报告

Dilemma Diagnosis Between Pulmonary Embolism and Amniotic Fluid Embolism During First Stage of Labor-A Case Report.

作者信息

Killinger Kristina, Riedel Fabian, Fiedler Mascha O, Müller Thomas, Wallwiener Markus, Wallwiener Stephanie, Elsässer Michael, Weigand Markus A, Böckler Dittmar, Erhart Philipp, Grieshaber Philippe, Hackert Thilo, Germann Günter, Scholz Anna Sophie

机构信息

Department of Gynecology and Obstetrics Heidelberg University Hospital Heidelberg Germany.

Department of Anesthesiology Heidelberg University Hospital Heidelberg Germany.

出版信息

Clin Case Rep. 2024 Nov 15;12(11):e9579. doi: 10.1002/ccr3.9579. eCollection 2024 Nov.

DOI:10.1002/ccr3.9579
PMID:39555203
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11567775/
Abstract

We report the sudden onset of dyspnea and loss of consciousness and fetal bradycardia in a middle-aged obese nulliparous woman at 39 weeks of gestation during first stage of labor leading to the decision for emergency cesarean section. Still during surgery, the mother underwent cardiac arrest. Transesophageal echocardiography during resuscitation showed right ventricular failure leading to the diagnosis of pulmonary embolism. Return of spontaneous circulation was achieved after emergency administration of thrombolysis with alteplase and cardiopulmonary resuscitation after 40 min. Severe bleeding, coagulopathy and persistent right ventricular failure resulted in persistent hemodynamic instability leading to supracervical hysterectomy and veno-arterial extracorporal life support. Both mother and baby survived without hypoxic brain injury.

摘要

我们报告了一名中年肥胖未产妇，在妊娠39周分娩第一产程中突然出现呼吸困难、意识丧失和胎儿心动过缓，遂决定行急诊剖宫产。术中母亲发生心脏骤停。复苏期间经食管超声心动图显示右心室衰竭，诊断为肺栓塞。紧急给予阿替普酶溶栓及40分钟心肺复苏后恢复自主循环。严重出血、凝血功能障碍和持续的右心室衰竭导致持续的血流动力学不稳定，进而行次全子宫切除术及静脉-动脉体外生命支持。母婴均存活，无缺氧性脑损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7bfa/11567775/6a6754b55dd8/CCR3-12-e9579-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7bfa/11567775/040edab2107e/CCR3-12-e9579-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7bfa/11567775/6a6754b55dd8/CCR3-12-e9579-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7bfa/11567775/040edab2107e/CCR3-12-e9579-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7bfa/11567775/6a6754b55dd8/CCR3-12-e9579-g003.jpg

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本文引用的文献

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Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review.越南图杜医院剖宫产术中前置胎盘合并急性肺栓塞时子宫成功保守治疗：病例报告及文献综述
Int J Emerg Med. 2024 Jan 29;17(1):14. doi: 10.1186/s12245-024-00587-4.
2
Systemic Thrombolysis for Treatment of Acute Life-threatening Pulmonary Embolism During Cesarean Section Followed by Post-partum Rescue Hysterectomy: A Case Report and Review of the Literature.剖宫产术后并发急性致命性肺栓塞行系统性溶栓治疗及产后即刻子宫切除术抢救成功：病例报告及文献复习。
In Vivo. 2023 Jan-Feb;37(1):498-502. doi: 10.21873/invivo.13106.
3
Cesarean section complicated with presumed massive pulmonary embolism and cardiac arrest treated with rescue thrombolytic therapy-two case reports.
剖宫产合并疑似大面积肺栓塞及心脏骤停并接受抢救性溶栓治疗——两例病例报告
Ann Palliat Med. 2023 Jan;12(1):219-226. doi: 10.21037/apm-22-435. Epub 2022 Sep 9.
4
The role of echocardiography in amniotic fluid embolism: a case series and review of the literature.超声心动图在羊水栓塞中的作用：病例系列及文献复习。
Can J Anaesth. 2021 Oct;68(10):1541-1548. doi: 10.1007/s12630-021-02065-4. Epub 2021 Jul 26.
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Echocardiographic diagnosis of amniotic fluid embolism with paradoxical embolism.超声心动图诊断羊水栓塞合并反常栓塞
Eur Heart J Cardiovasc Imaging. 2021 Sep 20;22(10):e150. doi: 10.1093/ehjci/jeab084.
6
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BMJ Case Rep. 2020 Apr 22;13(4):e234083. doi: 10.1136/bcr-2019-234083.
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