Author of this article: Sun Feng Song Lu Shan
Source: The Medical Circle Obstetrics and Gynecology Channel (ID: YXJ-FCK) article is cut
"More than 50 experts from various disciplines in the hospital participated in the rescue!
The city’s authoritative obstetric expert team came to the hospital to assist in rescue!
"The maternal blood transfusion exceeds 15,000 milliliters, and the blood storage type A of the hospital is anxious!"
"The maternal blood transfusion exceeds 30,000 ml, and the blood station A in the center of Tai’an City is anxious!"
Amniotic fluid embolism, the incidence of this obstetrics is very low (1.9 people/100,000-7.7 people/100,000), and the mortality rate (more than 80%) is extremely high complications. CurrentTwo diseases.
And this scene appeared in the First People’s Hospital of Ningyang County, Shandong.
Maternal who is chatting for amniotic fluid embolism
At around 9:20 am on October 19th, Ms. Wang, 36 -year -old pregnant mother, who was pregnant at 40+4 weeks of pregnancy, was normally checked in prenatal inspection.
Ms. Wang and the dysmenorrhea of the class chatted happily.From her husband’s gentle and considerate, to the eldest daughter’s well -behaved, to the little baby in the belly … however, this warm picture reversed in the sky after 10 minutes.
At about 9:30, Ms. Wang had a sudden chest tightness and asthma, and various monitoring indicators such as blood pressure, heart rate, and fetal heart also dropped rapidly.
Seeing this situation with more than 20 years of work experience, the nurses of the delivery room immediately realized that Ms. Wang was likely to be amniotic fluid embolism, and immediately launched an emergency plan and green channel.rescue.
Adults and children may have life -threatening at any time. After obtaining the consent of their families, the team of the second obstetrics and gynecology team performed a cesarean section for Ms. Wang.
At 9:55 am, after Ms. Wang successfully delivered a 3.7 kg of healthy baby girl, various life monitoring indicators also stabilized.The doctors’ hanging hearts calmed down slightly.
At this moment, the nurse who was observing the operating room found that Ms. Wang flowed out of the knife.
Liu Lan, Dr. and Director of Master and Gynecology, also received a report from the condensation function of the inspection department: D-Di Genter Testing> 40mg/L, 0.25mg/L fibrin, 45.72×109/L
From this moment, Ms. Wang has entered a 11 -day heavy coma!
Bleeding 3000ml!Multiple hemostatic methods are invalid
DIC (diffuse blood vessels)!
Acute amniotic fluid embolism!
A variety of hemostatic methods are invalid!
In the face of such a dangerous condition, many medical staff who have been medical for more than 20 years have not seen it. Even doctors who have encountered similar illnesses have no experience in rescue.
The maternal and family members and all medical staff present are facing an unprecedented crisis!
time is life!
After obtaining the consent of the family members, the doctor uterine resection for Ms. Wang urges, giving a large amount of blood transfusion and replenishment. At the same time, she reported to the medical department to ask experts from various disciplines in the hospital to assist in rescue.
After surgical investigation, no obvious active bleeding was found, and the surgery was ended and transferred to the Department of Severe Medicine (ICU) to continue rescue.
After surgery, Ms. Wang’s coagulation function is still good and bad, and the vagina continues to bleed a lot.
In the middle of the night on October 19, Ms. Wang was dangerous again, and the general blood pressure meter could not be measured. The use of arterial pressure was used to measure 60/30㎜Hg.
The crisis hit again.
The Second Department of Obstetrics and Gynecology and the Medical Medical Care Team immediately launched an emergency rescue.
Various first -aid equipment continued to run at a moment, and various first -aid drugs also continued to enter Ms. Wang’s blood vessels for a moment, maintaining her fragile life.
Within 24 hours, the abdominal drainage tube has a total drainage of about 6000ml dark red hemogenous solution, and the vaginal bleeding is about 5000ml.
The hospital quickly coordinated the team of authoritative obstetric experts in Tai’an Central Hospital to meet with the hospital for treatment to assist in treatment.
The expert group recommends a large amount of blood transfusion to improve the state of coagulation, but the effect is not good.
Conservative treatment?Still open your abdomen again!
In the anxious eyes of family members, doctors must give the answer about the choice of life.
Continuing conservative treatment may occur seriously complications such as DIC aggravation, cardiac arrest, dysfunction of multiple organs, and even death.
The possibility of opening abdomen detection is possible, but the risk is extremely high, and cardiac arrest or even the patient’s death may occur at any time.
After careful discussion, doctors decided to stop bleeding for Ms. Wang again.This solution has also been fully supported and trusted by family members.
The surgery was performed for nearly 8 hours.
During the surgery, the blood volume is 5000ml!
Blood transfusion!Blood transfusion!Blood transfusion!
As of this time, the amount of blood input for Ms. Wang has reached 15000ml.
After surgery, Ms. Wang’s vagina and abdominal blood reducing blood was significantly reduced, and her condition also improved slightly, which made the medical staff and their families see a little dawn.
The condition deteriorates again, and the city A blood is in a hurry
Before the medical staff was relieved, Ms. Wang’s condition deteriorated again.
On October 21, Ms. Wang reappeared vaginal bleeding again, and the abdominal drainage was seen with bright red bloody liquid flowing out, and systemic edema.
Nurse ICU, Zhao Hairong, said that at that time, the amount of bleeding was very large. The patient was like soaking in the blood. It had to change the care pad for more than ten minutes.
Such a large amount of bleeding has made the medical staff worried, but the greater difficulties hit again.
The hospital immediately coordinated with the blood station of Tai’an City. During the rescue, special vehicles were arranged to be responsible for transferring type A blood.
However, Ms. Wang was too large with blood, and she was urged by the blood reserve of Blood Station of the Central Blood Station of Tai’an!
The amount of bleeding is large, and the coagulation function is poor. Once the blood cannot keep up, the consequences will be unimaginable!
what to do?what to do?what to do?
At this time, a screenshot appeared in the WeChat group of the hospital’s employee-
"Hello, there is a maternal amniotic fluid embolism in Ningyang County First People’s Hospital, which requires a large amount of blood type A blood. I hope you will help you help and dedicate your love …"
The news received a positive response from the staff of the hospital, and employees of type A blood went to donate blood.
Zhang Yogang, a childhood doctor who was at work, immediately entrusted the work in his hand to his colleagues in his hand, and asked the director of the department to offer blood to donate blood.
He did not rest after donating blood, and quietly returned to his post to continue his work; after seeing the news, the doctor Sun Xin, who was planning to be in Tai’an, rushed to the Blood Station of Tai’an City for blood donation …
Netizens have forwarded Ms. Wang’s difficulties for the circle of friends. The loved friends of type A blood blood in Tai’an City rushed to the place of blood donation and put themselves a drop of life -saving blood that was full of temperature and love.Essence
In the following days, Ms. Wang’s condition improved.
Nevertheless, the medical staff did not dare to relax, because after DIC and a large amount of blood transfusion, Ms. Wang had a very large possibility of complications that might cause systemic organs to fail.
Acute renal failure … Various critical values come one after another
Ms. Wang’s facial puffiness, severe puffiness of the chest and abdomen walls, acute renal failure symptoms, and caused the functional failure of the whole body, such as respiratory systems, digestive systems, urinary systems, and internal environments.
All critical values come one after another.
Shen Huining, director of the Department of Severe Medicine (ICU), organized personnel to start rescue. At the same time, experts from relevant departments were asked to come to emergency consultation to assist in rescue.
◆ Continue giving gauze to fill in and compress the hemostatic; continue to give hemostatic, infection and boosting treatment;
◆ Continuous tracheal intubation area to connect the ventilator to assist breathing;
◆ Continue to infusion of suspended red blood cells, platelets, plasma, cold precipitation to correct anemia, supplement platelets and correct coagulation abnormalities;
◆ Given analgesia and sedation treatment, reduce stress reactions, and avoid irritability to increase bleeding;
◆ Apply drugs for preventing stress ulcers and liver prevention and enzymes;
◆ Right femoral vein tube;
◆ Cedicated blood filter;
◆ Anticated CRRT treatment of citrate citrates next to the bed …
After the multidisciplinary rescue of the whole hospital, under various treatment measures such as blood filtration and liver protection, Ms. Wang’s important organs have gradually improved.
On October 23, Ms. Wang began to fever, her body temperature reached 38.8 ° C, and Ms. Wang’s allergic constitution also made her with many rashes.
The Medical Department immediately organized a multi -disciplinary consultation to discuss the condition and treatment plan.
Because Ms. Wang had a large amount of blood loss, the low blood pressure time was long, and there was a hypoxic encephalopathy in considering the existence of ischemia; long -term bed also increased the incidence of thrombosis;big.
After discussion by experts from various departments, it was decided that human hemoglobin and diuretic drugs were continued to reduce cerebral edema and anti -infective treatment, protect the function of the organ, and maintain the internal environmental stability.
Ms. Wang repeatedly tested the technical, spiritual and mentality of medical staff. After each rescue, the medical staff summarized their experience, estimate risks, and discussed the next treatment and emergency plan.
When communicating with Ms. Wang’s family, Ms. Wang’s husband said:
"" Even if there is a sigh of relief, no matter how the result is, everything will be listened to you, I believe you!"
The phrase "I believe you" has made the medical staff more firm the confidence of treating Ms. Wang.
In their words, "I don’t think about the consequences, as long as Ms. Wang still has a hint of hope, we will not give up rescue and treatment!"
After adjusting the treatment plan, Ms. Wang’s fever gradually controlled, the coagulation function improved, the amount of bleeding gradually decreased, and her condition became stable.
On October 30, Ms. Wang, who was unconscious for 11 days, finally opened her eyes slowly.She said, she felt that she had slept for a long time …
During the 11 -day rescue process, the help of the hospitals, medical staff, family members, and people from all walks of life gave her. She could only experience it slowly from the words described by friends, family or doctors and nurses around her.
After the rest of my life, no matter how hard it is, it will be worth it!
On November 4th, after confirming that Ms. Wang’s various functions were well recovered and their life signs were stable, the doctor removed the tracheal intubation for her and transferred to the general ward to observe and treat.
Watching Ms. Wang recovered day by day, the heart of all medical staff was gradually let go.
"When she can chat with me and communicate with me how to educate children, I know we have successfully rescued her."
Deputy Chief Physician in charge of the obstetrics and gynecology department was a little excited when he said here, with tears in his eyes.
"In the days of rescue, the medical careers of our department had almost no rest. I remember that I had a meal in 3 days … Everyone was in a highly nervous state, no matter who was free, she went to her bed and guarded her bed.She was thinking about pulling her back … "Deputy Chief Physician Liu Lan of the Second Madage and Gynecology Section choked and choked.
"I was the first time I met such a critical patient. I was very nervous at the time. This rescue made me learn a lot of valuable experience." Ms. Wang’s attending doctor Zheng Jingjing sighed.
"The situation was too urgent at the time, and the patients were constantly bleeding. All staff of our sciences were busy giving her blood, blood, and blood transfusion …" said Guo Qingjun, director of the Department of Anesthesiology.
"On the day of the rescue, more than 40 bags of blood lost during the operation. Usually, there were few patients who lost so many blood in such a short time …" Zhu Meiping, the nurse of the operating room, recalled the thrill in the "fighting".
"Patients who have been treated with amniotic fluid before, but have never received such a heavy one, whether it is the amount of bleeding or the amount of blood input, this is the first time …" Shen Huining, director of ICU, breathed a sigh of relief.
Captain ICU, Zhao Hairong, then said, "In the case of being very nervous, we took out people to specialize. After pulling the trachea intubation that day to see her eating, combing her hair, chatting with her, watching a big mouth and eatingWith noodles, I can’t bear to tell her the test and death test she experienced these days … "
Deputy Chief Physician Liu Lan, director of the second subject of obstetrics and gynecology, said that amniotic fluid embolism is extremely low, but the mortality rate is as high as 80%, and Ms. Wang’s merging DIC is even more dangerous.
During this rescue, Ms. Wang entered a total of 34649ml of blood products, and more than 100 bags of rescue blood was rescued on the night of the operation.
More than 50 medical staff in more than 10 departments in the hospital participated in the rescue, and the secondary and ICU teams were observed and treated in 24 hours.
"Ms. Wang said, she seems to have a long dream, and the dream is very dark, but she can hear her child calling her mother. She also saw her eldest daughter running downstairs and waiting for her to ask her why she would not return.Home, she thought she must go back, she must go home, and go back to take care of her children. "
Medical staff participating in the rescue have stated that they can pull Ms. Wang back from the death line.
Acute amniotic fluid embolism, DIC!
In order to help, the doctor replaced the blood in Ms. Wang 7 times … In this thrilling life rescue, I would like to thank too many people, then thank all those who participated in the treatment and cooperation with the treatment!
"Tribute to the great medical staff!
I also hope that every mother can produce smoothly!"
Article Source: Medical Circle Obstetrics and Gynecology Channel (ID: YXJ-FCK) has been authorized to reprint, please contact the original author
Author of this article: Sun Fengsong Lu Shan, the First People’s Hospital of Ningyang County
Audit expert: Han Yan, deputy chief physician of obstetrics and gynecology
What is acute amniotic fluid embolism?
Amniotic fluid embolism refers to amniotic fluid containing fetal feces and fragmented amniotic fluid into the mother’s blood, causing the mother to have a similar allergic shock response. It also contains some coagulative substances.Damage and even life -threatening.(Source: Health Times)
Article Source: Medical Obstetrics and Gynecology Channel (ID: YXJ-FCK Author: Ningyang County First People’s Hospital Sun Fengsong Lu Shan) has been authorized to reprint, please contact the original author
Part of the point in this article comes from: Health Times (JKSB2013)
Image source: Medical Circle Obstetrics and Gynecology Channel