Ludwig H
Seminar für Gynäkologie, Universität Basel.
Ther Umsch. 1996 Jun;53(6):477-96.
The survey on emergencies in Obstetrics is addressed here to practitioners and advanced medical students. The specialized gynecologist will, however, find some case reports interspersed illustrating what he/she has already experienced sometimes. The paper should be a refreshment for them. Acute abdominal pain in pregnancy challenges the diagnostic skills of the physician first contacted. Is it, what causes the pain, appendicitis as is frequently in nonpregnant young women, or gall-bladder disease as in the elderly obese, or even dangerous intestinal obstruction, or is the pain deriving from a twisted pedicle of an occult ovarian cyst or is it simple gastrointestinal discomfort? Putting into account the differing frequency of incidences of disease does not always help. Emergency may arise from the rarest event. With increasing traffic on our streets blunt trauma occurs and it might hurt pregnant women as well as their fetus. Even seat-belts can cause damages, if pelvic belts are used instead of shoulder belts. Traumata from accidents are often associated to immediate shock. Shock in pregnancy poses different questions according to the physiology of the progressing pregnancy. There is a variety of shock etiologies. Bleeding from the vagina is the most common complaint. Those can be harmless or they can be the first and leading sign of imminent danger to the fetus and the mother. Diagnosis does not allow any delay. One of the most striking complications in late pregnancy is described by the acronym "HELLP"-syndrome [hemolysis, elevated liver enzymes, low platelets]. This syndrome is a critical complication of preeclampsia. One third of the cases occur after delivery. It has not yet been clearly decided whether active management including immediate delivery by cesarean section in disregard of the maturity of the child, or the conservative approach with intensive care, drastic antihypertensive medication and additional serial plasmapheresis might prove to be more efficient in terms of live-saving for mother and child. The mortality of mothers suffering from HELLP remains to be high, the perinatal mortality is even higher. Post partum hemorrhage is due to the lack of contractibility of the uterus after overdistension, protracted labour, malpositions, mere inertia etc., from lacerations, or from placental retention. It is always an emergency with hemorrhagic shock impending. The risk situation around even normal birth is well known. Emergencies will appear every time unannounced. There are post partum risks as well; they should not be underestimated when home-delivery is desired.
本文面向产科从业者和高年级医学生探讨产科急症。不过，专业妇科医生也会发现文中穿插了一些病例报告，阐述了他们有时已经经历过的情况。本文对他们而言应能起到复习回顾的作用。孕期急性腹痛对首诊医生的诊断技能构成挑战。疼痛的病因是什么呢？是像非孕期年轻女性常见的阑尾炎，还是老年肥胖者易患的胆囊疾病，甚至是危险的肠梗阻，又或是源自隐匿性卵巢囊肿蒂扭转，亦或是单纯的胃肠道不适？考虑疾病发生率的差异并不总能有所帮助。急症可能源于最罕见的情况。随着街道上交通流量增加，钝性创伤时有发生，可能会伤及孕妇及其胎儿。如果使用骨盆带而非肩带，安全带甚至也可能造成损伤。事故导致的创伤常伴有即刻休克。孕期休克根据妊娠进展的生理情况会引发不同问题。休克病因多种多样。阴道出血是最常见的主诉。这些出血可能无害，也可能是胎儿和母亲即将面临危险的首要且主要迹象。诊断不容有任何延误。妊娠晚期最显著的并发症之一用首字母缩写词“HELLP”综合征来描述（即溶血、肝酶升高、血小板减少）。该综合征是子痫前期的一种严重并发症。三分之一的病例发生在产后。对于不顾胎儿成熟度立即行剖宫产的积极处理方式，与采用重症监护、强效降压药物及额外连续血浆置换的保守治疗方式，哪种在母婴挽救生命方面更有效，目前尚无明确定论。患有HELLP综合征的母亲死亡率仍然很高，围产期死亡率甚至更高。产后出血是由于子宫过度扩张、产程延长、胎位异常、子宫收缩乏力等导致子宫收缩性缺乏，或是因撕裂伤或胎盘滞留引起。这始终是一种有出血性休克风险的急症。即使是正常分娩周围的风险情况也是众所周知的。急症随时可能毫无预兆地出现。产后也存在风险；如果希望在家分娩，这些风险不应被低估。
