羊水栓塞:
Amnionicfluidembolism
Amnionicfluidentersthecirculationasaresultofabreachinthephysiologicalbarrierthatnormallyexistsbetweenmaternalandfetalcompartments.Sucheventsappeartobecommon,ifnotuniversal,withbothsquamesofpresumedfetaloriginandtrophoblastsbeingcommonlyfoundinthematernalcirculation.Theremaybematernalexposuretovariousfetalelementsduringtrauma,ormorecommonlyduringlaborordeliveryassmalllacerationsdevelopintheloweruterinesegmentorcervix.Alternately,cesareansectionaffordsampleopportunityformixtureofmaternalbloodandfetaltissues.
子宫破裂:
uterinerupture
uterinerupturemaydevelopasaresultofpreexistinginjuryoranomaly,itmaybeassociatedwithtrauma,oritmaycomplicatelaborinapreviouslyunscarreduterus.
Ruptureoftheuterusmaycommunicatedirectlywiththeperitonealcavity(complete)ormaybeseparatedfromitbythevisceralperitoneumovertheuterusorthatofthebroadligament(incomplete).
胎膜早破:
PretermRupturedMembranes.Anintenseinflammatoryreactionatthesiteofprematurelyrupturedmembraneswasnotedasearlyas1950,andthissuggestedinfection.McGregorandcolleagues(1987)demonstratedthatinvitroexposuretobacterialproteasesreducedtheburst-ingloadoffetalmembranes.Thus,microorganismsgivenaccesstofetalmembranesmaybecapableofcausingmembranerupture,pretermlabor,orboth.
BacterialVaginosis.Bacterialvaginosisisaconditioninwhichthenormal,lactobacillus-predominantvaginalfloraisreplacedwithanaerobicbacteria,Gardnerellavaginalis,andMycoplasmahominis(Hillierandcol-leagues,1995).Diagnosticfeaturesinclude(1)vaginalpHgreaterthan4.5,(2)anamineodorwhenvaginalse-cretionsaremixedwithpotassiumhydroxide,(3)vagi-nalepithelialcellsheavilycoatedwithbacilli("cluecells"),and(4)fewwhitecellswithamixedflora(ascomparedwiththenormalpredominanceoflacto-bacilli)onGramstainingofvaginalsecretions.Bacterialvaginosishasbeenassociatedwithpretermbirth,pretermrupturedmembranes,infectionofthechorionandamnion,aswellasamnionicfluidinfection(Hillierandcolleagues,1995).Platz-Christensenandcolleagues(1993)haveprovidedsomeevidencethatbacterialvagi-nosismayprecipitatepretermlaborbyamechanismsimilartothecytokinenetworkpathwayproposedforamnionicfluidbacteria(Pig.34-4).Incontrast,Thorsenandassociates(1996),inaprospectivestudyof3600Danishwomen,foundthatbacterialvaginosisdiagnosedbefore24weekswasnotrelatedtorupturedmembranesbefore37weeksortolowbirthweight.