国际妇产科学杂志

国际妇产科学杂志 ›› 2025, Vol. 52 ›› Issue (5): 581-584.doi: 10.12280/gjfckx.20250323

• 产科生理及产科疾病: 病例报告 • 上一篇    下一篇

一例足月胎膜早破催产后发生难治性产后出血的原因分析

沈攀圆, 杨倩, 刘乐南, 晋柏()   

  1. 210029 江苏省人民医院（南京医科大学第一附属医院，江苏省妇幼保健院）产科
  • 收稿日期:2025-03-30 出版日期:2025-10-15 发布日期:2025-10-16
  • 通讯作者: 晋柏 E-mail:jinbai1018@yeah.net
  • 基金资助:
    江苏省卫生健康委医学科研重点项目(ZD2022023)

Analysis of the Causes of Refractory Postpartum Hemorrhage after Induction of Labor in A Case of Premature Rupture of Membranes at Term

SHEN Pan-yuan, YANG Qian, LIU Le-nan, JIN Bai()   

  1. Department of Obstetrics, Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University, Jiangsu Women and Children Health Hospital), Nanjing 210029, China
  • Received:2025-03-30 Published:2025-10-15 Online:2025-10-16
  • Contact: JIN Bai E-mail:jinbai1018@yeah.net

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摘要：

难治性产后出血的病因迥异，少数病例实际诊断为非典型羊水栓塞，因临床上难以识别且病情凶险，按照产后出血常规治疗往往难以奏效，严重威胁母儿生命。报告1例患者因足月胎膜早破行缩宫素和地诺前列酮栓序贯催引产，临产后产程进展迅速，发生胎儿窘迫，阴道助产后出现严重产后出血，迅速采取多学科紧急救治，母儿转归良好。该患者临产后血小板下降，产后短时间内发生无法解释的严重凝血功能障碍，考虑为弥散性血管内凝血（disseminated intravascular coagulation，DIC）型羊水栓塞。回顾分析该患者的诊治过程发现，规范有羊水栓塞高危因素孕妇的催引产措施十分必要，应严密观察临产后异常征象，及时识别羊水栓塞，迅速采取紧急救治措施，保障母婴安全。

关键词: 产后出血, 栓塞，羊水, 足月分娩, 胎膜早破, 引产, 催产素

Abstract:

The etiology of refractory postpartum hemorrhage vary greatly. A small number of cases are actually diagnosed as atypical amniotic fluid embolism. Since it is difficult to identify clinically and the condition is critical, the routine treatment for postpartum hemorrhage is often ineffective, seriously threatening the lives of the mother and the fetus. A case is reported in which a patient underwent sequential induction of labor with oxytocin and dinoprostone suppositories due to premature rupture of membranes at term. After the onset of labor, the labor progressed rapidly, fetal distress occurred, and severe postpartum hemorrhage occurred after vaginal assisted delivery. Multidisciplinary emergency treatment was promptly carried out, and the outcomes of the mother and the fetus were good. After the onset of labor, the patient's platelet count decreased, and unexplained severe coagulation dysfunction occurred shortly after delivery. It was considered to be disseminated intravascular coagulation (DIC)-type amniotic fluid embolism. A retrospective analysis of the diagnosis and treatment process of this patient reveals that it is very necessary to standardize the induction of labor measures for pregnant women with high-risk factors for amniotic fluid embolism. Abnormal signs after the onset of labor should be closely observed, amniotic fluid embolism should be identified in a timely manner, and emergency treatment measures should be taken promptly to ensure the safety of the mother and the infant.

Key words: Postpartum hemorrhage, Embolism, amniotic fluid, Term birth, Fetal membranes, premature rupture, Labor, induced, Oxytocin