Challenges in the diagnosis and management of amniotic fluid embolism in pregnant women / 中国实用妇科与产科杂志

Amniotic fluid embolism(AFE)is a rare obstetric complication. Because of the rarity of this condition, most physicians have limited experience in the management of AFE. The purpose of this article is to provide clinicians with opinion that may improve the ability to make an early diagnosis,and to establish appropriate supportive treatment for patients suffering from AFE to improve maternal and fetal outcomes.

Conservative Treatment of the Displaced Clavicular Shaft Fracture in Multiple Injury

PURPOSE: To analyse the comparative clinical results between adults with multiple injury including the clavicular shaft fracture and only clavicular shaft fracture who had supportive care through retrospective aspect. MATERIALS AND METHODS: We had 48 adult patients in this hospital with simple fracture and multiple injury including the clavicular shaft whom we were able to evaluate at least more than a year. 12 of 48 patients were with only clavicular shaft fracture and the rest of them were with multiple injury. We classified patients into two groups those who had fracture with displacement for group A (A1 for the cases with over 50% of fracture surface contact rate and A2 for less than 50% from the images of simple X-ray) and those who had comminuted fracture for B. We compared the time of bone union, nonunion rate of only clavicular fractures and multiple injury, clinical results for patients who had supportive care with retrospective aspect. RESULTS: A1 (7 cases), A2 (4 cases), B (1 case) were prevalent in the group of only clavicular shaft fracture and A1 (8 cases) and A2 (16 cases) and B (12 cases) were prevalent in the group of multiple injury. For the cases with supportive care, we could find 1 nonunion case (8%) and 11 union cases on average 2.91 months in the group of only clavicular shaft fracture and 7 nonunion cases (19%) and 29 union cases on average 3.58 months in the group of multiple injury. The best clinical results had occurred in 8 cases (67%) of only clavicular shaft fracture group and 19 cases (53%) of multiple injury group. We could find out the union from all 8 nonunion cases that took operation afterward. CONCLUSION: Although the choice of treatment of clavicular fracture is supportive care, but multiple injury including the clavicular fracture is a high-energy injury, so the possibility of comminuted and displacement is high, so that nonunion rate is high. The possibility of early surgery must be considered seriously.