In these two months, there are three cases of maternal complications of amniotic fluid embolism during delivery, although the end is different, but each time is a national sensation, the first case is a New Oriental employee, unfortunately died after delivery, Yu Minhong as the boss of the righteous blast Putian system, medical V have speculated that the biggest cause of death may be amniotic fluid embolism; the second case is the maternal death in Xiangtan, due to the language tendency of the media and the family fussed the hospital The second case was the maternal death in Xiangtan, which stirred up the medical, legal and general netizens, and this time all the big V’s came forward, and the medical community started to bombard the amniotic fluid embolism, both for the general public and for the continuing education of professionals. But after the medical staff’s efforts to save the patient’s life, the doctor showed the photos through WeChat: 53 bags of blood, busy medical care, and warming the blood with body temperature, which visually let everyone understand the difficulty of amniotic fluid embolism and the hardship of doctors.
Amniotic fluid embolism can have a very rapid onset and may cause cardiac arrest without any warning, and it is said that the patient of a woman and baby had sudden cardiac arrest. If the patient can survive this, she will eventually enter the stage of intractable postpartum hemorrhage – DIC. after delivery, the uterus, the placental abruption trauma will run like an open floodgate.
But anyway, amniotic fluid embolism is a rare case, one in 100,000, and some doctors have never seen it or resuscitated it in their lifetime.
However, it is not only amniotic fluid embolism that causes postpartum hemorrhage, there are many reasons that can cause postpartum hemorrhage. For example, the uterus cannot contract after delivery, such as placenta residue, placental implantation, placental abruption, birth canal injury, or blood clotting disorders before delivery.
The incidence of amniotic fluid embolism is one in tens of thousands, but the incidence of postpartum hemorrhage is much higher than that, about 2-3%, and is almost daily in hospitals with a large number of deliveries.
In the past, we considered postpartum hemorrhage to be more than 500 ml. But the fact is that we greatly underestimated the amount of postpartum bleeding, the general vaginal births are about 300-400ml of blood loss, while 70-80% of cesarean deliveries will reach 700-800ml. 500ml is a bottle of mineral water, 1000ml is 2 bottles, I we women in general the whole body of blood month 4000-5000ml or so.
God is so unfair to women, when not pregnant bleeding once a month, once the menstruation is a little more, it will be anemic. Finally pregnant, ten months without a period, but the nutrients in the blood is not effectively preserved, need a constant supply of fetal. You give birth, but just about everything is normal and you will have 1-2 bottles of blood. If it is not normal, there will be more bleeding, and once the bleeding goes into shock, it may also enter the DIC stage, which is the same as amniotic fluid embolism, a difficult to treat postpartum bleeding stage.
One of the most memorable postpartum hemorrhages in my practice was a patient I saw during a shift more than a decade ago. I was on duty when the nurse informed me that an ambulance had brought in a patient with postpartum hemorrhage. The patient was 22 years old and had a private delivery at home. I don’t know how long she had been in labor, but the baby was born dead, and the family buried the baby and placenta. After a few hours, the woman was bleeding a lot, the family panicked and called an ambulance to bring the woman to our hospital. The first time I saw the patient, I saw that the patient was weak and pale, and there was a pool of blood on the mattress underneath her. The blood pressure had dropped to 40/30 mmHg and the patient was in shock. Since the patient did not have a labor and delivery and bleeding did not occur in the hospital, it was difficult for the doctor to determine the cause and amount of bleeding. The hospital urgently gathered people and started various tests and resuscitation and family talks. There was no placenta and we didn’t know if it was a retained placenta, and we didn’t know if the uterus was ruptured because of the out-of-hospital delivery. At one point during the resuscitation process, the blood pressure dropped to zero, the heart rate was only 30 beats, and the patient was on the verge of death. I went to talk with the family, who was so scared that their legs kept shaking. We made an immediate decision to remove the uterus. After the hysterectomy, the bleeding did not continue, but the patient also entered the DIC stage, and the wound wound started to ooze blood, so we did not dare to suture the wound. The pelvis was compressed with gauze, and various hemostatic drugs were started to be given, and finally various coagulation indicators were normalized in a few hours. The patient’s blood pressure, heart rate, respiration, and coagulation function were all normal, and everyone breathed a sigh of relief: the patient was finally snatched back from death. The gauze was removed, the wound was sutured, and the patient was sent to the observation room. Next, we found that the patient was urinating less than 300ml a day, and the patient entered the post-shock phase of renal failure, so we transferred the patient to the nephrology department for hemodialysis three days after the operation, after giving increased rehydration and diuresis without relief.
The patient saved her life but lost so much, lost her baby, lost her uterus, and lost her health.
This example was due to a home delivery, but postpartum hemorrhage can occur even in hospitals, and death from postpartum hemorrhage occurs every year in large cities with excellent medical care, such as in the North.
Postpartum hemorrhage is very dangerous, and in mild cases, hemorrhagic anemia can occur; in severe cases, life can be lost. Once in shock DIC stage, treatment is very difficult. Even if the resuscitation is successful, it may affect health in the long run, for example, most patients who enter DIC have to have their uterus removed, and then they really can’t have children again; they need a lot of blood transfusion, and blood transfusion can also bring complications from blood transfusion, such as infection with hepatitis B, hepatitis C, AIDS, etc. In severe cases of shock, renal failure may occur, and in the distant future, pituitary dysfunction called Silhan’s syndrome may occur, in which several endocrine functions of the patient are impaired, and the incidence of this is very high.
How to treat postpartum hemorrhage and how to resuscitate I will not talk about here, this is a necessary quality for obstetricians.
Can postpartum hemorrhage be prevented? Sometimes postpartum hemorrhage occurs inexplicably without any reason or sign. But the joint efforts of doctors and patients will reduce the amount of postpartum hemorrhage that should not be reversed and can reduce the amount of postpartum hemorrhage.
What can you do as a mother and future mother to reduce the occurrence of postpartum hemorrhage?
Get good birth control if you don’t want to have children. Induced abortion can seriously affect future fertility, possible infertility, possible placental implantation, placenta praevia, etc., and these are one of the main causes of postpartum bleeding.
The diet should be controlled to keep your weight and the weight of the fetus within the ideal range. If the fetus is too big and the uterus is overinflated, postpartum bleeding will easily occur due to poor contraction.
Don’t ask for a cesarean section for no reason. A very smooth cesarean delivery also bleeds 300-400ml more than a normal delivery. Cesarean delivery is more prone to bleeding due to weak contraction of the uterus, and may also be caused by wound problems. Cesarean delivery should only be used as a last resort in difficult deliveries. If you are afraid of labor pains, then there is labor analgesia to help you.
Be sure to have your checkups on time. Regular checkups can identify some of the risk factors for postpartum hemorrhage, so you can take preventive and curative measures in advance. Be sure to give birth in a hospital, too. Childbirth is a high-risk physiological process in any case, which is the reason for the high maternal mortality rate before the widespread implementation of hospital births. During childbirth, our physical condition can take a sharp turn for the worse, and this process requires the watchful eye of a doctor, who comes to the rescue at critical moments.
I believe that when a doctor does any treatment, especially resuscitation, he weighs all the measures he takes many times in his mind: should he use them or not? Will it be effective? When he told you to get a blood transfusion and cut the uterus, he was also very determined to talk to you.
I wish all women in the world a good delivery.