massive amniotic fluid aspiration
Introduction
A large amount of amniotic fluid inhalation The fetus inhales a larger amount of amniotic fluid during intrauterine or childbirth, and refers to a large amount of alcoholic fluid inhalation (massive aminoticfluidaspiration), also known as amniotic fluid inhalation syndrome (aminoticfluidaspirationsydrom). Generally speaking, amniotic fluid is not contaminated, often has a transient difficulty breathing or bruising, mild symptoms and good prognosis. Such as the inflammatory reaction in the lungs, known as amniocentesis pneumonia. basic knowledge The proportion of illness: 0.001% Susceptible people: good for newborns Mode of infection: non-infectious Complications: aspiration pneumonia respiratory failure
Cause
A large number of amniotic fluid inhalation causes
Fetal hypoxia (20%):
Any factor causes hypoxia in the intrauterine or postpartum period. Hypoxemia stimulates the fetal respiratory center, causing respiratory breathing, causing amniotic fluid to be inhaled into the respiratory tract. Amniotic fluid is quickly absorbed by the alveolar capillaries after inhalation, and sebum in the amniotic fluid and shedding The keratinized epithelial cells can cause chemical and mechanical stimuli in the alveoli to cause diffuse pneumonia, which reduces the gas diffusion function.
Abnormal delivery (12%):
Abnormal labor is also called dystocia. Its main feature is that the progress of the labor process is slow and prolonged. Factors that cause abnormal delivery include productivity, birth canals, fetuses, and maternal psychosocial factors. Prolonged labor will increase maternal and child complications during childbirth, and severe cases can directly endanger mother and child life.
Intrauterine distress (10%):
Intrauterine distress is caused by fetal hypoxia, most of which occurs after labor, but can also occur during pregnancy. Intrauterine distress is a common cause of fetal perinatal death and neonatal nervous system sequelae, accounting for the first cause of perinatal death. Can be divided into acute fetal distress and chronic fetal distress.
Huge fetus (10%):
Fetal weight 4000g is called a huge fetus. Difficulties often occur in the normal birth canal, there are many opportunities for shoulder dystocia, and surgery is needed for midwifery. If the treatment is improper, soft birth canal injury or uterine rupture can occur.
Prevention
Large amount of amniotic fluid inhalation prevention
The key to prevention is prevention of intrauterine or hypoxia in the fetus. It is very necessary for the mother to do prenatal checkup regularly. When the fetus has signs of intrauterine asphyxia, the delivery should be terminated as soon as possible. The longer the hypoxia, the possibility of inhaling amniotic fluid. And the amount of amniotic fluid inhaled will be larger, and long-term intrauterine hypoxia can also cause fetal brain damage. In the moment when the child is delivered, the child's nose and mouth, pharyngeal cavity and amniotic fluid in the atmospheric tube should be intubated as soon as possible to avoid the child's birth. When crying, the amniotic fluid in these areas is inhaled into the deeper lungs, which further aggravates the condition.
Complication
A large number of amniotic fluid inhalation complications Complications, aspiration pneumonia, respiratory failure
Can be complicated by pneumonia, etc., developed into amniocentesis pneumonia.
Most of these children have intrauterine hypoxia, such as increased or slowed fetal heart rate, increased or decreased fetal movement, etc., also need oxygen, artificial respiration and other rescue at birth, after the rescue, the child soon has shortness of breath, asthma Hey, the complexion or the skin of the whole body is blue, and the mouth or the nasopharynx has more secretions or foam.
Pulmonary examination can hear wet rales, inhaled amniotic fluid, mild symptoms, 3-4 days can be improved, the more amniotic fluid inhaled, the more serious the symptoms, and even lead to respiratory failure, due to the amount of amniotic fluid inhaled How much different, chest X-ray film performance is also different, lighter only increased lung texture, and severe cases can show patchy shadows in both lungs, more prominent inside and below the lungs.
Symptom
A large number of amniotic fluid inhalation symptoms Common symptoms Acute dyspnea Difficulty after birth, there are persistent cyanotic lips and nail bed slightly greenish purple cyanosis in the water echo enhancement increased lip blue and purple lung texture thickening
The fetus has a history of intrauterine distress or postpartum distress, dyspnea after resuscitation, bruising, mild symptoms and how much amniotic fluid inhalation, less inhalation, clinical asymptomatic or shortness of breath, mass production of amniotic fluid inhalation may also be fetal death, Survivors can shed fluid or foam from the mouth, and the lungs are auscultated with a coarse wet rales.
Examine
Large amount of amniotic fluid inhalation check
X-ray showed less lung inhalation, only the lung texture was thickened, with a slight shadow, with mild or moderate emphysema. Those with more inhalation showed patchy shadows with lighter density, and patchy distribution during large inhalation. Wide, but with the inner side of the lungs and the bottom of the lungs is significant.
Diagnosis
Large amount of amniotic fluid inhalation diagnosis
diagnosis
The fetus has a history of intrauterine distress or postpartum distress, dyspnea after resuscitation, bruising, mild symptoms and how much amniotic fluid inhalation, less inhalation, clinical asymptomatic or shortness of breath, mass production of amniotic fluid inhalation may also be fetal death, Survivors can shed fluid or foam from the mouth, and the lungs are auscultated with a coarse wet rales.
X-ray showed less lung inhalation, only the lung texture was thickened, with a slight shadow, with mild or moderate emphysema. Those with more inhalation showed patchy shadows with lighter density, and patchy distribution during large inhalation. Wide, but with the inner side of the lungs and the bottom of the lungs is significant.
Differential diagnosis
Identification with milk aspiration pneumonia.
1. Symptoms of primary disease that cause inhalation: If the baby's milk from swallowing dysfunction flows out of the nasal cavity, coughing occurs at the same time, sometimes the baby with a blind end of the cyanotic esophagus is stuck in the pharynx, and there is a voice in the esophagus. Those who suffer from cough, shortness of breath and bruising during feeding are prone to galactorrhea.
2, respiratory symptoms and signs: severity is related to the amount and frequency of inhalation, inhaled or accidental inhalation is mainly bronchitis, symptoms of cough and asthma, shortness of breath, pneumonia, a large amount of inhalation, can cause a large inhalation Asphyxia, after the breathing stops to recover from breathing, there is obvious shortness of breath. Pulmonary fibrosis or pulmonary bronchiectasis occurs in the lungs with long-term inhalation.
3, X-ray performance: early due to foreign body stimulation of the bronchi, sputum, not completely obstructed X-ray showed extensive emphysema and bronchial changes, lung hilar widening, lung texture thickening or inflammation of the patch Repeated inhalation involves the interstitial and forms interstitial pneumonia.
