Эмболия околоплодными водами

Эмболия околоплодными водами
МКБ-11 JB42.1
МКБ-10 O88.1
МКБ-9 673.1
MeSH D004619
Логотип Викисклада Медиафайлы на Викискладе

Эмболия околоплодными водами — осложнение при бурной родовой деятельности, предлежании плаценты, преждевременной отслойке нормально расположенной плаценты, связанное с попаданием амниотической жидкости в лёгочный кровоток матери.

Впервые описано в 1926 году, в начале 40-х годов XX века выделено, как самостоятельный акушерский синдром.

Эпидемиология

В разных странах показатели отличаются, усредненным значением считается 1 случай на 20 000 родов.

Эмболия околоплодными водами составляет существенную часть материнской смертности, в России (2015 г.) — 8,2-10,3 %[1].

Факторы риска

Симптомы, течение

Острое начало, падение артериального давления вплоть до шока (ниже 90 мм рт. ст.), может развиться энцефалопатия, характеризующаяся изменением психического статуса и возникновением судорог (у 10-15 % пациентов наблюдаются тонико-клонические судороги)[1].

Характерно появление цианоза, одышки, клокочущего дыхания, пенистой мокроты, нередки нарушения свертывающей системы крови, а именно ДВС-синдром (присутствует более, чем у 83 % пациенток), атония матки, вследствие чего развивается массивное маточное кровотечение[1]. Возможна остановка дыхания и сердечной деятельности.

Лечение

Срочный перевод больной на искусственную вентиляцию легких, инфузии противошоковых растворов с выраженным реологическим действием, назначение десенсибилизирующих средств, при возникновении маточного кровотечения — мероприятия, направленные на его остановку.

Примечания

  1. ↑ 1 2 3 4 Эмболия амниотической жидкостью: Интенсивная терапия и акушерская тактика. Клинические рекомендации // Министерство здравоохранения. — 2017. Архивировано 26 октября 2020 года.

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