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02 July 2019, Volume 35 Issue 7 Previous Issue    Next Issue

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Challenges in the diagnosis and management of amniotic fluid embolism in pregnant women. 2019, 35(7): 731-734.  DOI: 10.19538/j.fk2019070102 Abstract ( )   Amniotic fluid embolism（AFE）is a rare obstetric complication. Because of the rarity of this condition, most physicians have limited experience in the management of AFE. The purpose of this article is to provide clinicians with opinion that may improve the ability to make an early diagnosis，and to establish appropriate supportive treatment for patients suffering from AFE to improve maternal and fetal outcomes.

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Epidemiological status and pathophysiological changes of amniotic fluid embolism. YANG Meng-yuan，ZHANG Wen 2019, 35(7): 735-739.  DOI: 10.19538/j.fk2019070103 Abstract ( )   Amniotic fluid embolism is a rare and catastrophic complication during pregnancy.This study combines the international clinical and experimental researches about amniotic fluid embolism in the past ten years，and analyzes the epidemiological characteristics and pathophysiological changes of amniotic fluid embolism.，aiming to complete the theory of amniotic fluid embolism and improve a program for prevention，diagnosis and treatment of the amniotic fluid embolism.

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Clinical manifestation and early identification of amniotic fluid embolism. LYU Xin，LIN Jian-hua 2019, 35(7): 739-742.  DOI: 10.19538/j.fk2019070104 Abstract ( )   Amniotic fluid embolism（AFE）is a rare and extremely dangerous condition in obstetrics.Clinical manifestations can be divided into cardiopulmonary failure and coagulation dysfunction.The onset can be acute or slow.The main clinical manifestations include prodrome，cardiopulmonary failure，bleeding and coagulation disorder，systemic organ damage，and fetal distress etc.The earlier we identify the symptom，the earlier we can intervene and perform the treatment in order to reduce the mortality of AFE.

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Diagnostic criteria for amniotic fluid embolism. LIAN Yan，WANG Xie-tong 2019, 35(7): 742-746.  DOI: 10.19538/j.fk2019070105 Abstract ( )   Amniotic fluid embolism is a rare and serious pregnancy complication and is an important cause of maternal death .Up to now，amniotic fluid embolism still lacks a clear and unified diagnostic standard，and it is only an exclusion diagnosis based on the clinical manifestations such as pulmonary hypertension，hypoxemia，hypotension，and coagulation dysfunction before massive hemorrhage that cannot be explained during labor and within 30 minutes after delivery.It is not recommended that any laboratory diagnosis be used for the diagnosis or exclusion of AFE，but blood routine，coagulation function，blood gas analysis，electrocardiogram，myocardial enzyme spectrum，chest X-ray，echocardiography，thromboelastic diagram，and hemodynamic monitoring are helpful for the diagnosis，condition monitoring and treatment of amniotic fluid embolism.Early treatment can improve the prognosis，so for every case of sudden pulmonary hypertension，hypoxemia，hypotension，coagulation dysfunction and other maternal symptoms，the possibility of amniotic fluid embolism should be considered.For clinically highly suspected amniotic fluid embolism，treatment can be performed before a definite diagnosis.

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Differential diagnosis of amniotic fluid embolism. WANG Yuan-yuan，ZHAO Yang-yu 2019, 35(7): 746-749.  DOI: 10.19538/j.fk2019070106 Abstract ( )   Amniotic fluid embolism（AFE）is one of the leading causes of maternal mortality.Our understanding of its diagnosis，differential diagnosis and treatment is hampered by the nonspecific clinical manifestation and a lack of uniform definition.AFE is often overdiagnosed or missed in peripartum women.It makes great significance to improve perinatal outcomes through differential and early diagnosis of AFE.

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Fluid management of amniotic fluid embolism. LI Bin，NIU Jian-min 2019, 35(7): 749-753.  DOI: 10.19538/j.fk2019070107 Abstract ( )   The effective fluid resuscitation and management can not only save time for subsequent treatment measures but also lay the foundation for correcting blood loss and coagulation dysfunction，which helps avoid organ damage due to volume disorder during the treatment of amniotic fluid embolism（AFE）.Amniotic fluid embolism management includes three parts：the phase of controlling volume load in right heart failure to avoid aggravation of pulmonary edema，maintain hemodynamic stability，the fluid resuscitation in cycle support phasea and restrictive fluid resuscitation in DIC phase.

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Interdisciplinary treatment for the amniotic fluid embolism. YUAN Zi-ming，LI Ying-chuan 2019, 35(7): 753-756.  DOI: 10.19538/j.fk2019070108 Abstract ( )   Amniotic fluid embolism is a rare but extremely dangerous complication in pregnant women.Its pathogenic pathophysiological nature is an immune process of the mother.This cascade endogenous immune response can quickly cause multiple organ dysfunction of the mother.Therefore，the treatment for this disease requires a multi-disciplinary and close collaborative medical rescue team in order to ensure the maternal and fetal safety in China.

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Pulmonary hypertension caused by amniotic fluid embolism. LIU Yan-yan，FENG Ling 2019, 35(7): 756-759.  DOI: 10.19538/j.fk2019070109 Abstract ( )   Positive cardiopulmonary resuscitation is a guarantee for successful rescue.To remove pulmonary hypertension as soon as possible is the key to successful treatment.Dobutamine and milrinone have the effect of strengthening the heart and expanding the pulmonary artery，which is the drug of first choice for treatment.

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Glucocorticoid use in amniotic fluid embolism. ZHOU Yang-zi，LYU Yuan 2019, 35(7): 759-761.  DOI: 10.19538/j.fk2019070110 Abstract ( )   This paper discussed the use of glucocorticoids in amniotic fluid embolism treatment by analyzing the pathophysiological basis of amniotic fluid embolism and the pharmacological effects of glucocorticoids，and expounded the viewpoints and controversial issues supporting the application of glucocorticoids in amniotic fluid embolism.The conclusion is that there is no evidence to support the conventional use of glucocorticoids in the treatment of amniotic fluid embolism，although there is theoretical basis.It is controversial to use or not use large doses of glucocorticoids.

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Management of DIC and the controversy about usage of heparin in amniotic fluid embolism. SU Fang-ming 2019, 35(7): 761-765.  DOI: 10.19538/j.fk2019070111 Abstract ( )   Disseminated intravascular coagulation（DIC）is one of the major etiologies behind the pathological change of amniotic fluid embolism（AFE）.The depletion of coagulation factor and the damage of red blood cell  were common manifestations of DIC，which can also promote the formation of pulmonary hypertension.Meanwhile，DIC is also the main reason of hemorrhage of AFE.The detection of DIC at an early stage facilitates the clinical diagnosis of AFE.Preventing procoagulants from getting into the maternal circulation and anticoagulant therapy may be profitable to prevent the deterioration of DIC.Heparin should be both employed at the stage of hypercoagulation and the early stage hypocoagulation .Simultaneously，the supplement of coagulation factor is also crucial.The change of coagulation function must be closely monitored.

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Obstetric management of amniotic fluid embolism. HE Jing，LIANG Cheng 2019, 35(7): 765-768.  DOI: 10.19538/j.fk2019070112 Abstract ( )   This paper focuses on the obstetric management of amniotic fluid embolism，including the problems of perimortem cesarean section，the use of contractions and the operation of obstetric hysterectomy ，so as to optimize the outcome of patients and reduce the mortality.

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Role of hysterectomy in management of amniotic fluid embolism. JIANG Yan-min，ZHENG Qin-tian 2019, 35(7): 768-771.  DOI: 10.19538/j.fk2019070113 Abstract ( )   Hysterectomy is the ultimate management option for uterine hemorrhage.If other less invasive methods are unable to control the life-threatening uterine bleeding in the management of amniotic fluid embolism，hysterectomy should be immediately performed.However，hysterectomy is not the primary or necessary treatment in most cases and prophylactic hysterectomy should never be performed.The indications，techniques and perioperative management are discussed in the article.

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Team process rescue in amniotic fluid embolism. XIAO Xi-rong，LI Xiao-tian 2019, 35(7): 771-774.  DOI: 10.19538/j.fk2019070114 Abstract ( )   Amniotic fluid embolism（AFE）is a rare complication that threatens the maternal and fetal life.Early identification and initiation of the rapid response team（RRT）and the correct rescue protocol can improve the prognosis.Unnecessary obstetrical interventions should be avoided to reduce the risk of AFE.Medical center should make standardized rescue protocol for AFE and implement standardized treatment.Establishing a RRT to perform early identification and implementation of multidisciplinary treatment is the key to successful rescue.Periodic training and simulations can improve communication skills and comprehensive treatment capabilities in a team emergency.