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羊水栓塞:病例系列

Amniotic fluid embolism: A case-series.

作者信息

Jaya-Bodestyne Sandra Lynn, Tan Wei Ching, Kanagalingam Devendra, Yong Tze Tein, Nadarajah Ravichandran, Tan Lay Kok, Yang Liying

机构信息

Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, Singapore.

出版信息

Obstet Med. 2025 Mar 21:1753495X251326125. doi: 10.1177/1753495X251326125.

Abstract

Amniotic fluid embolism (AFE) is a rare but potentially catastrophic pregnancy complication. This is a 10-year retrospective study on women with AFE from 2014 to 2023. Cases that met Clark's criteria or in whom a clinical diagnosis was made after exclusion of other causes were included. Information on clinical characteristics, treatment, complications and outcomes were collected and analysed. Four cases of AFE were identified. Two met Clark's criteria and presented with cardiac arrest requiring extracorporeal membrane oxygenation, of which one had cognitive and functional impairment. Two women had atypical AFE, one with disseminated intravascular coagulation (DIC)-type AFE who did not survive, and another who had paradoxical intracranial emboli from a patent foramen ovale, who had full recovery. All had coagulopathy and postpartum haemorrhage. Early recognition and initiation of cardiovascular support is crucial in AFE. DIC and haemorrhage should be treated aggressively. Survival and good outcomes of AFE are possible.

摘要

羊水栓塞(AFE)是一种罕见但可能具有灾难性的妊娠并发症。这是一项对2014年至2023年期间患有羊水栓塞的女性进行的为期10年的回顾性研究。纳入符合克拉克标准的病例或排除其他病因后作出临床诊断的病例。收集并分析了临床特征、治疗、并发症及结局方面的信息。共识别出4例羊水栓塞病例。2例符合克拉克标准,出现心脏骤停,需要体外膜肺氧合治疗,其中1例有认知和功能障碍。2名女性患有非典型羊水栓塞,1例为弥散性血管内凝血(DIC)型羊水栓塞,未能存活,另1例因卵圆孔未闭出现矛盾性颅内栓塞,但已完全康复。所有患者均有凝血病和产后出血。早期识别并启动心血管支持对羊水栓塞至关重要。应积极治疗弥散性血管内凝血和出血。羊水栓塞患者有可能存活并获得良好结局。

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本文引用的文献

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Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States.羊水栓塞:美国 20 年发病率和病死率趋势。
Eur J Obstet Gynecol Reprod Biol. 2024 Mar;294:92-96. doi: 10.1016/j.ejogrb.2023.12.034. Epub 2024 Jan 4.
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Comment on: "amniotic fluid embolism - implementation of international diagnosis criteria and subsequent pregnancy recurrence risk".
J Perinat Med. 2021 Sep 10;49(9):1163-1164. doi: 10.1515/jpm-2021-0375. Print 2021 Nov 25.
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ECPR-extracorporeal cardiopulmonary resuscitation.体外心肺复苏术
Indian J Thorac Cardiovasc Surg. 2021 Apr;37(Suppl 2):294-302. doi: 10.1007/s12055-020-01072-2. Epub 2021 Jan 7.

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