Recently, several high-profile doctor-patient disputes have involved \”amniotic fluid embolism.\” What exactly is amniotic fluid embolism? What is the pathogenesis? How to carry out effective rescue? Can it be prevented? In this regard, Lu Junli, director of the obstetrics department of Beijing Chaoyang Hospital, recently said in an interview with relevant media that amniotic fluid embolism is a bit like a plane crash. The incidence rate is very low, but once it occurs, the fatality rate is extremely high.
Lu Junli said that amniotic fluid embolism is a series of allergic reactions caused by the mother to fetal antigens after amniotic fluid enters the maternal circulation. It is similar to penicillin allergic reactions, but faster than penicillin allergic reactions. She further analyzed that the amniotic fluid enters the lungs through the venous circulation, and the tangible substances contained in the amniotic fluid will remain in the lungs. After these foreign bodies enter, the lungs instantly twitch and lose their function. Due to lack of oxygen in the body, disseminated intravascular coagulation occurs and maternal hemorrhage occurs. If a mother is given a blood transfusion, the rate of blood transfusion cannot keep up with the rate of bleeding. A pulmonary embolism is like a toppling domino, creating a chain reaction that can lead to anaphylactic shock and ultimately death.
Why is it sometimes too late to rescue amniotic fluid embolism? Lu Junli explained that sometimes pregnant women just sigh or cough, and their heart suddenly stops beating, and amniotic fluid embolism occurs so quickly. As for chronic embolism, the clinical manifestations are sometimes atypical, and some are just bleeding without shortness of breath, making it difficult for clinicians to judge.
Once amniotic fluid embolism is determined, clinical rescue also takes time. Lu Junli said that the treatment of embolism generally involves the following steps: first, tracheal intubation, second, blood transfusion, and third, infusion. The first thing to do when doing a blood transfusion is to match the blood so that the blood type can be matched. Bloodline matching takes time. Coagulants used to stop bleeding are usually stored at -20 degrees Celsius, and infusions need to be thawed before being used on patients. To rescue the patient, 23 veins need to be opened, even deep veins. The entire process requires at least 7 to 8 medical staff. Without regular drills, it would be difficult to organize rescue operations in time.
An important method to stop bleeding is hysterectomy. Removing the uterus cuts off the source of amniotic fluid. After a woman gives birth, her uterine cavity is like a huge wound, and every wound will become a bleeding outlet, just like a broken embankment. Blood spurts out and cannot be stopped at all. Lu Junli regrets that sometimes hysterectomy cannot save her life. This is a reality that pregnant women and their families must face.
Is there any way to prevent this dangerous amniotic fluid embolism? Lu Junli said helplessly that amniotic fluid embolism is impossible to prevent. Although the incidence rate is low, the number of cases is considerable due to the large number of pregnant women. She hopes that the society will learn more about it, and hospitals should consciously strengthen drills in this area, improve clinical awareness, and ensure the safety of mothers and infants. Wang Junping