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This study was conducted to investigate whether the use of tourniquet after delivery of the fetus could reduce the amount of amniotic fluid entering the bloodstream and thus reduce the incidence of intraoperative adverse events.
Amniotic fluid embolism (AFE) is a rare complication specially to obstetrics.When amniotic fluid enters the maternal circulation , a sudden onset of a series of pathophysiologic changes such as pulmonary hypertension, hypoxemia, circulatory failure, disseminated intravascular coagulation, and multiorgan failure may occur. Routinely, the typical AFE triad is uneasy to discover, and nonspecific adverse reactions such as irritability, chills, chest tightness and shortness of breath, transient drop in blood pressure, and nausea and vomiting are often seen during delivery of the fetus and placenta. All of the above symptoms may suggest that the amniotic fluid has entered into the bloodstream. In clinical anesthesia, investigators observed that women with placenta praevia and placenta implantation were less likely to suffer these nonspecific symptoms after delivery of the fetus compared with women with normal pregnancies.The investigators speculated it might be related to the fact that obstetricians used tourniquets to reduce intraoperative hemorrhage in the former, blocking venous return to the lower uterine segments to reduce the inflow of amniotic fluid into the uterus. Therefore, this study was conducted to investigate whether the use of tourniquet after delivery of the fetus could reduce the amount of amniotic fluid entering the bloodstream and thus reduce the incidence of intraoperative adverse events.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| tourniquet | Experimental | The investigators use tourniquets to bind the cervical for intervention groups to block venous return to the lower uterine segments to reduce the inflow of amniotic fluid into the uterus. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| tourniquet binding of cervical | Procedure | The procedure will be performed by surgeons with rich experience in clinical work |
|
| Measure | Description | Time Frame |
|---|---|---|
| sTn | sTn refers to meconium and mucin extracted from amniotic fluid. The presence of sTn in the patient's serum is a diagnostic method that can directly prove that mucin derived from amniotic fluid has entered the maternal circulation. | before the fetus is delivered,after the fetus is delivered,before the puerpera is sent back to the ward |
| Measure | Description | Time Frame |
|---|---|---|
| HR MAP | Measurement of HR by patient monitor and MAP by placing an arterial puncture catheterization. | before the fetus is delivered,after the fetus is delivered,before the placenta is delivered,after the placenta is delivered,after releasing the tourniquet,before the puerpera is sent back to the ward |
| SPO2,PaO2,PaCO2 |
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Inclusion criteria
Exclusion criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yingying Zhou | Contact | +861861202387 | zyy172250133@163.com | |
| Yao Chen | Contact | +8615115563778 | chenyao0810@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Zhiming zhang | Chenzhou NO. 1 people's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zhiming Zhang | Chenzhou | Hunan | 423000 | China |
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| ID | Term |
|---|---|
| D004619 | Embolism, Amniotic Fluid |
| D006976 | Hypertension, Pulmonary |
| ID | Term |
|---|---|
| D011249 | Pregnancy Complications, Cardiovascular |
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
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the respiratory parameters in arterial blood gas |
| before the fetus is delivered,after the fetus is delivered,before the placenta is delivered,after the placenta is delivered,after releasing the tourniquet,before the puerpera is sent back to the ward |
| Thrombelastogram(TEG) | Thrombelastography (TEG) is an indicator of the dynamic changes of blood coagulation. It can evaluate thrombelastography and compensate for the failure of routine examinations to reflect the fibrinolytic system and platelet function. | before the fetus is delivered,before the puerpera is sent back to the ward |
| Adverse events | Irritability, chills, chest tightness and shortness of breath, transient drop in blood pressure, and nausea and vomiting | perioperatively |
| Hemorrhage | The using of tourniquets can reduce intraoperative hemorrhage. The postpartum hemorrhage reflects the coagulation function of patients. | before the puerpera is sent back to the ward, 2 hours after the puerpera back to ward |
| D002318 | Cardiovascular Diseases |
| D004617 | Embolism |
| D016769 | Embolism and Thrombosis |
| D014652 | Vascular Diseases |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D006973 | Hypertension |