中国医科大学妇产科学英文课件 Amniotic Fluid Embolism+Fetal Distress.pptVIP

Amniotic Fluid Embolism Page 251 Defition Amniotic Fluid Embolism is a complex condition characterized by the abrupt onset of pulmonary embolism, shock and DIC. Incidence varies greatly. Etiology Pressure increasing: uterinehypertonus,tetanic,oxytocin open vessles:traumatic, laceration membrane changing:fetal death,dystocia pathophysiology Emblus(amniotic fluid component+fibrin)allergic reaction --mechanic block+vagus nerve(spasm)blood return decreasingperipheral circulation faiture --hypertetion of pulmonary arterypulmonary edemaleft heart faiure+respiratory failure --general ischemia—renal failure --coagulopathyDIC Clinical manifestation A. time of onset B. circulation and respiratory failure C. DICbleeding D. renal failure diagnosis Emergent : typical clinical manifestation Pulmonary edema Definitive diagnosis: aspiration:debris +DIC autopsy treatment 1.correct RC failure 2.correct coagulopathy, DIC, renal dysfunction 3.Anti-allergic reaction 4.obstetric management You should rember! It is axiomatic that when a choice must be made, maternal considerations take perference over those of the fetus Prognosis Perinatal outcomes are dismal with amniotic fluid embolism. Few conditions in medicine have potential for such sudden devastation. We are aware of one case during labor in which mother and baby not only died, but the visiting grandmother also suffered a fatal myocardial infarction during resuscitation efforts on her daughter! Chapter 20genetic counseling, genetic screening, prenatal diagnosispage202 Genetic counseling 1.significance of genetic counseling 2.steps A.make the definitive diagnosis genetic disease/congenital disease/familial disease/ B.predict the effects on their offspring Autosomal dominant disease:expressed even when only one chromosome of a pair carries an abnormal allele Autosomal recessive disease: expressed only when both chromosomes of a pair carry an abnormal allele. X-linked dominant X-linked recessive