WordNet

subject to change; variable; "a fluid situation fraught with uncertainty"; "everything was unstable following the coup" (同)unstable
a substance that is fluid at room temperature and pressure
continuous amorphous matter that tends to flow and to conform to the outline of its container: a liquid or a gas
in cash or easily convertible to cash; "liquid (or fluid) assets" (同)liquid
affording change (especially in social status); "Britain is not a truly fluid society"; "upwardly mobile" (同)mobile
characteristic of a fluid; capable of flowing and easily changing shape (同)runny
an insertion into a calendar (同)intercalation
occlusion of a blood vessel by an embolus (a loose clot or air bubble or other particle)
of or related to the amnion or characterized by developing an amnion; "amniotic membrane" (同)amnionic, amnic

PrepTutorEJDIC

『流体』,流動体 / 『流動性の』,流動する / 流体の,流動体から成る / 変わりやすい,固定していない,浮動する
塞栓(そくせん)症(血管に塞栓が詰まること)
インフルエンザ,流感

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/28 22:58:24」(JST)

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Presence of intravascular squames in amniotic fluid embolism

Pathophysiology of the amniotic fluid embolism^[1]

An amniotic fluid embolism (AFE) is a rare childbirth (obstetric) emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and triggers an allergic-like reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and massive hemorrhaging (coagulopathy). It was first formally characterized in 1941.^[2] While it is rare (between 1 in 8000 and 1 in 80,000 deliveries), the high mortality makes it the fifth most common cause of maternal mortality in the world, in some estimates.^[3]

Presentation

The condition is rare (between 1 in 8000 and 1 in 80,000 deliveries).^[4]

When the fluid and fetal cells enter the maternal pulmonary circulation there is profound respiratory failure with deep cyanosis and cardiovascular shock followed by convulsions and profound coma, in a first and second phase.

First phase

In the first phase, the patient experiences acute shortness of breath and hypotension. This rapidly progresses to cardiac failure leading to a reduction of perfusion to the heart and lungs. This may be accompanied by other "premonitory symptoms" such as shivering, coughing, vomiting, and an unpleasant taste in the mouth. Not long after this stage the patient will lose consciousness due to circulatory collapse. While previously believed to have a maternal mortality rate of 60-80%, more recently it has been reported at 26.4%.^[5]

Second phase

About 40 percent of the initial survivors will pass onto the hemorrhagic phase. The blood loses its ability to clot and there is excessive bleeding. Collapse of the cardiovascular system leads to fetal distress and death unless the child is delivered swiftly.

Causes

It is thought that this condition results from amniotic fluid entering the maternal circulation via the uterine veins, which then has either a direct effect on the lungs, or triggers an immune response in the mother.^[6]

In order for amniotic fluid to enter the maternal circulation, there are three prerequisites:

Ruptured membranes (a term used to define the rupture of the amniotic sac)
Ruptured uterine or cervical veins
A pressure gradient from uterus to vein

Although exposure to fetal tissue is common and thus finding fetal tissue within the maternal circulation is not significant, in a small percentage of women this exposure leads to a complex chain of events resulting in collapse and death.

There is some evidence that AFE may be associated with abdominal trauma ^[4] or amniocentesis.^[7] A 2006 study showed that the use of drugs to induce labor, such as misoprostol, nearly doubled the risk of AFE. A maternal age of 35 years or older, caesarean or instrumental vaginal delivery, polyhydramnios, cervical laceration or uterine rupture, placenta previa or abruption, eclampsia, and fetal distress were also associated with an increased risk.^[8]

Treatment

There is no specific treatment for amniotic fluid embolism, and initial emergency management is the same as for any other cause of sudden maternal collapse - with cardiovascular and respiratory resuscitation and correction of the coagulopathy.^[9] However, newer research with animal models suggest that significant embolism of any material is followed by platelet degranulation, pulmonary hypertension due to serotonin and thromboxane, and systemic hypotension due to vagal stimulation. Armed with this knowledge, several women have survived and regained a pulses immediately after ondansetron, metoclopramide, atropine, and ketorolac were administered.^[10]^[11] One emergency intervention which has been applied is an immediate caesarean section.^[12]

Recurrence

According to review published in 2009, a total of 9 cases of successful pregnancy following AFE, with no instances of recurrent AFE, have been reported in the literature. Therefore, although the available information is limited, the current evidence suggests that AFE is not a recurrent disease.^[13]

References

^ Alfredo Gei, Gary D. V. Hankins: Amniotic fluid embolus: An update. Contemp Ob/Gyn 45 (2000), pp. 53–66, online.
^ Stafford I, Sheffield J (2007). "Amniotic fluid embolism". Obstet. Gynecol. Clin. North Am. 34 (3): 545–53, xii. doi:10.1016/j.ogc.2007.08.002. PMID 17921014.
^ Moore J, Baldisseri MR (2005). "Amniotic fluid embolism". Crit. Care Med. 33 (10 Suppl): S279–85. doi:10.1097/01.CCM.0000183158.71311.28. PMID 16215348.
^ ^a ^b Ellingsen CL, Eggebø TM, Lexow K (2007). "Amniotic fluid embolism after blunt abdominal trauma". Resuscitation 75 (1): 180–3. doi:10.1016/j.resuscitation.2007.02.010. PMID 17467876.
^ Gilbert WM, Danielsen B (June 1999). "Amniotic fluid embolism: decreased mortality in a population-based study". Obstet Gynecol 93 (6): 973–7. doi:10.1016/s0029-7844(99)00004-6. PMID 10362165.
^ N J McDonnell, V Percival, M J Paech (Aug 2013). "Amniotic fluid embolism: a leading cause of maternal death yet still a medical conundrum". International journal of obstetric anesthesia. doi:10.1016/j.ijoa.2013.08.004.
^ Dodgson J, Martin J, Boswell J, Goodall HB, Smith R (May 1987). "Probable amniotic fluid embolism precipitated by amniocentesis and treated by exchange transfusion". Br Med J (Clin Res Ed) 294 (6583): 1322–3. doi:10.1136/bmj.294.6583.1322. PMC 1246486. PMID 3109636.
^ Kramer, M.S.; Rouleau, Jocelyn; Baskett, Thomas F; Joseph, KS (2006). "Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study". The Lancet 368 (9545): 1444–1448. doi:10.1016/S0140-6736(06)69607-4. PMID 17055946.
^ N.F. Collins, M. Bloor, N.J. McDonnell (2013). "Hyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism". International Journal of Obstetric Anesthesia 22 (1): 71–76. doi:10.1016/j.ijoa.2012.09.008.
^ http://soap.org/display_2013_abstract.php?id=S%2047
^ http://www.marchofdimes.org/pdf/missouri/AFE_11-21-13.pdf
^ Stehr SN, Liebich I, Kamin G, Koch T, Litz RJ (2007). "Closing the gap between decision and delivery--amniotic fluid embolism with severe cardiopulmonary and haemostatic complications with a good outcome". Resuscitation 74 (2): 377–81. doi:10.1016/j.resuscitation.2007.01.007. PMID 17379383.
^ Conde-Agudelo, Agustín; Romero, Roberto (2009). "Amniotic fluid embolism: an evidence-based review". American Journal of Obstetrics and Gynecology 201 (5): 445.e1–445.e13. doi:10.1016/j.ajog.2009.04.052. ISSN 0002-9378.

External links

Histology at University of Utah
California Woman Who Survived the 'Most Feared Complication of Childbirth' Now Advocates for Other Mothers, People magazine. (Factually correct article in popular magazine that serves as good introduction to the topic.)

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 羊水塞栓症候群 amniotic fluid embolism syndrome
2. 妊娠中および周産期における急性呼吸不全 acute respiratory failure during pregnancy and the peripartum period
3. 妊婦および授乳婦におけるアナフィラキシー anaphylaxis in pregnant and breastfeeding women
4. 成人における播種性血管内凝固の臨床的特徴、診断、および治療 clinical features diagnosis and treatment of disseminated intravascular coagulation in adults
5. 妊娠中および周産期の重症疾患 critical illness during pregnancy and the peripartum period

English Journal

Variation in severe maternal morbidity according to socioeconomic position: a UK national case-control study.

Lindquist A, Knight M, Kurinczuk JJ.SourceNational Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
BMJ open.BMJ Open.2013 Jun 20;3(6). pii: e002742. doi: 10.1136/bmjopen-2013-002742. Print 2013.
OBJECTIVES: This study aimed to explore the independent association between socioeconomic position, defined by occupation, and severe maternal morbidity among women in the UK.DESIGN: Case-control study.SETTING: The analysis was conducted as a case-control analysis, using data from a series of studie
PMID 23794588

Acute Hypotension Associated with Intraoperative Cell Salvage Using a Leukocyte Depletion Filter During Management of Obstetric Hemorrhage Due to Amniotic Fluid Embolism.

Rogers WK, Wernimont SA, Kumar GC, Bennett E, Chestnut DH.SourceFrom the *Department of Anesthesiology, University of Wisconsin Hospital and Clinics; †Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health; ‡Department of Anesthesiology, Meriter Hospital; §Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison; and ‖Department of Anesthesiology, Gundersen Lutheran Health System, La Crosse, Wisconsin.
Anesthesia and analgesia.Anesth Analg.2013 Jun 7. [Epub ahead of print]
Amniotic fluid embolism (AFE) is a rare but catastrophic obstetric complication that can lead to profound coagulopathy and hemorrhage. The role of cell salvage and recombinant human Factor VIIa (rFVIIa) administration in such cases remains unclear. We present a case of AFE and describe our experienc
PMID 23749444

Japanese Journal

1)妊産婦死亡登録事例の原因分析からみた予防対策新しい妊産婦死亡登録制度の概要について(II.脳性まひと母体死亡事例の分析からみた予防対策,日産婦医会共同企画症例から学ぶ-ハイリスク妊娠への対応,第63回日本産科婦人科学会第63回学術講演会生涯研修プログラム,研修コーナー)

関沢明彦
日本産科婦人科學會雜誌 63(12), "N-270"-"N-276", 2011-12-01
NAID 110008799080

Related Pictures

Amniotic Fluid - Definition and Function | Biology Dictionary Amniotic Fluid Embolism - Creative Med Doses Embolism, Amniotic Fluid PPT - AMNIOTIC FLUID EMBOLISM (AFE) PowerPoint Presentation, free download - ID:5756663

★リンクテーブル★

リンク元	「羊水塞栓症」「羊水塞栓」
関連記事	「emboli」「flu」「amniotic」「fluid」

「羊水塞栓症」

Amniotic fluid embolism
Classification and external resources
Specialty	obstetrics
ICD-10	O88.1
ICD-9-CM	673.1
DiseasesDB	574
eMedicine	med/122
MeSH	D004619

　　[★]

英: amniotic embolism, amniotic fluid embolism
ラ: embolia liquolis amnii
関: 産科ショック。肺塞栓症

概念

妊婦の破水後、特に分娩開始後に、羊水成分が母体内に流入して引きおこされる急性呼吸循環不全および播種性血管内凝固症候群(DIC)を呈する重篤な病態である。
発症頻度は6-8万分娩に1例であるが、母体の死亡率は60-80%と著しく高い。
歴史的には1941年SteinerとLushbauchの報告が最初とされている(PMID 3514978 https://pubmed.ncbi.nlm.nih.gov/3514978/)。
病態生理は明らかではないころが多い。
診断が難しく、死亡率が高いために医療過誤を疑われることが多い。

病態生理

羊水成分・胎児成分(胎児扁平上皮、ムチン、胎便など)が母体の静脈に入り、肺血管に塞栓を生じる。急性肺循環不全や急性右心不全、また羊水成分によりDICを起こし、性器出血にて死亡に至る。
病態としては肺血管閉塞→肺高血圧→呼吸循環不全、播種性血管内凝固、SIRSの流れで起こる。
羊水成分の血液内の流入は、卵膜破綻した後に、子宮筋層断裂部や子宮内腔に露出する欠陥破綻部から起こるとされている
胎児成分による物理的な閉塞、ないし血管攣縮性物質による肺血管攣縮により肺血管抵抗が上昇して肺高血圧を来たし、左室の機能低下、低酸素血症を来す
羊水中の組織因子やプロテアーゼなどの血管内への流入により血管内血液凝固が引きおこされ、血管内皮障害を来すとされる。