About the author:
Tan Xianjie, MD. Gynecological oncologist, chief physician, professor and master's supervisor of Peking Union Medical College Hospital. Vice chairman of the Youth Committee of the Gynecological Oncology Branch of the Chinese Medical Association, editorial board member of the Chinese Journal of Practical Gynecology and Obstetrics, editorial board member of the Chinese Journal of Gynecology and Obstetrics and Family Planning, and assistant editor in chief of the obstetrics and gynecology volume of the Chinese Medical Encyclopedia. Born in Chongqing in December 1970, he graduated from West China Medical University in 1993 and has worked in Beijing Union Medical College Hospital since then. From 2005 to 2006, he went to the University of Paris in France to conduct postdoctoral research on gynecological tumors. She is mainly engaged in the diagnosis and treatment of gynecological tumors and endometriosis, and has accumulated rich clinical experience. At present, more attention has been paid to cervical diseases and cervical cancer.
In the past, the birth of children by women was called "the gate of death", and many women would lose their precious lives because of human reproduction. The development of modern medicine has made it possible for most women to pass this pass easily. The odds of success are far higher than certainty, and even require that there is no risk. It is sad that there is still a certain probability of death.
In a popular science book on women's health I was writing, in order to ease women's unnecessary fear of pregnancy and childbirth, I comforted women friends by saying that under the escort of modern medical technology, pregnancy and childbirth are relatively safe, and women friends need not worry too much. However, experts say that aircraft is the safest means of transportation. Recently, there have been a series of reports of air crash. Fortunately, people will not give up flying because of fear of air crash, and human beings will not stop breeding because of the danger of pregnancy and childbirth. Because, after all, it is a small probability event.
There are at least the following cases of death of pregnant women during cesarean section:
1. Anesthesia accident; 2. Cardio cerebrovascular accident; 3. Amniotic fluid embolism; 4. Massive bleeding.
Generally speaking, massive bleeding during operation gives doctors more chances of successful rescue. If other conditions are not combined, such as abnormal coagulation function or amniotic fluid embolism, the puerpera will rarely die on the stage due to uncontrollable bleeding. If not, the uterus can be removed, and the bleeding can usually be controlled.
Anesthesia accidents and cardiovascular and cerebrovascular accidents are sudden and even unpredictable in many cases. Just like a person can have no problem at ordinary times, but he will fall down after running 1500 meters or marathon.
Amniotic fluid embolism is a fatal emergency in obstetrics. It may be said that amniotic fluid embolism actually murdered the mother! Why? Amniotic fluid embolism (AFE) is defined as a serious delivery complication caused by acute pulmonary embolism, anaphylactic shock, disseminated intravascular coagulation, renal failure or sudden death when amniotic fluid suddenly enters the maternal blood circulation during delivery. The incidence rate is 4/100000 to 6/100000. It is generally believed that amniotic fluid embolism is caused by the tangible substances in amniotic fluid (fetal vellus hair, keratinized epithelium, fetal fat, meconium) entering the maternal blood circulation. When the pressure in the amniotic sac is increased (uterine contraction is too strong), the fetal membrane is broken, the placenta is stripped, or the uterus is damaged, amniotic fluid may enter the blood circulation through the open venous sinus. At present, it is believed that amniotic fluid embolism can be induced by the first delivery of a woman over 35 years of age, multiple deliveries, spontaneous or artificial uterine contractions, acute labor, premature rupture of membranes, placenta previa, placental abruption, cesarean section, etc. The typical clinical features are sudden drop of blood pressure, tissue hypoxia and consumptive coagulation dysfunction before and after delivery. In typical amniotic fluid embolism, the parturient may suddenly shiver, cough, shortness of breath, restlessness, nausea, vomiting and other symptoms, followed by dyspnea, cyanosis, convulsions, sharp drop in blood pressure, and rapid coma. In case of serious illness, the puerpera will suddenly stop breathing and heartbeat with only one scream or yawn or twitch, and die within a few minutes. After going through cardiopulmonary failure and shock, the patient enters the stage of coagulation dysfunction, showing a tendency of systemic bleeding, mainly uterine bleeding, and bleeding can occur everywhere in the body. Then there is renal failure. For more information, click http://baike.baidu.com/view/291126.htm
The mortality rate of amniotic fluid embolism is very high, previously said to be 100%, which is too absolute, just as there are occasionally survivors in air disasters. The eighth edition of Obstetrics and Gynecology said that the mortality rate was 60%, but it was generally believed that it was as high as 80%! Most of the time, no matter how skillful a doctor is, he has no way out. N years ago, I successfully rescued a pregnant woman with amniotic fluid embolism following the senior obstetrician. However, not every time, not every doctor, every patient has such good luck.
Extended reading:
What's the matter with amniotic fluid embolism
http://www.baikemy.com/jiankangkepu/2422010285825
Amniotic Fluid Embolism
http://www.baikemy.com/disease/detail/1026/1
