Peripartum Embolism

2017 ◽  
Author(s):  
Elizabeth M. S. Lange ◽  
Paloma Toledo
Keyword(s):  
Risk Factors ◽  
Amniotic Fluid ◽  
Maternal Morbidity ◽  
Clinical Presentation ◽  
Air Embolism ◽  
Common Type ◽  
Amniotic Fluid Embolism ◽  
Maternal Risk ◽  
Venous Air Embolism ◽  
Maternal Morbidity And Mortality

Embolic disease during pregnancy is a significant contributor to maternal morbidity and mortality. The most common type of embolism is venous air embolism, but this is rarely symptomatic or hemodynamically significant. However, both thromboembolism and amniotic fluid embolism (AFE) are associated with significant maternal risk, and in the case of AFE, frequent major hemodynamic sequelae and fatal results ensue. As each class of embolic disease has slightly different risk factors, pathophysiology, clinical presentation, and treatment, they will each be discussed in separate sections in this chapter with an overview of these components.

scholarly journals Tips on Amniotic Fluid Embolism

2021 ◽  
Vol 16 (2) ◽  
pp. 22-24
Author(s):  
Kayvan Aflaki ◽  
Sena Aflaki ◽  
Joel Ray
Keyword(s):  
Risk Factors ◽  
Amniotic Fluid ◽  
Clinical Setting ◽  
Clinical Presentation ◽  
Facteurs De Risque ◽  
Sudden Onset ◽  
Amniotic Fluid Embolism ◽  
Prise En Charge ◽  
Supportive Treatment ◽  
Perinatal Morbidity

Amniotic fluid embolism (AFE) is a catastrophic, sudden-onset event that must be recognized immediately. Despite the rarity of this condition, both maternal and perinatal morbidity and mortality are significant with AFE, even in cases ideally managed. In this article, we present five key statements covering the risk factors, clinical presentation, and management of AFE in a clinical setting. The purpose of these tips is to provide clinicians with information that may improve their ability to make a timely diagnosis and establish appropriate supportive treatment to patients suffering from AFE. RésuméL’embolie amniotique est un événement catastrophique d’apparition soudaine qui doit être détecté immédiatement. Malgré la rareté de cette affection, la morbidité et la mortalité maternelles et périnatales sont importantes, même dans les cas où le traitement est idéal. Dans cet article, nous présentons cinq énoncés clés qui portent sur les facteurs de risque, le tableau clinique et la prise en charge de l’embolie amniotique dans un contexte clinique. Ces astuces visent à fournir aux cliniciens de l’information qui pourrait améliorer leur capacité à poser un diagnostic en temps opportun et à assurer un traitement de soutien approprié aux patientes atteintes d’une embolie amniotique.

scholarly journals Methodology for sampling women at high maternal risk in administrative data

2019 ◽  
Author(s):  
Jennifer Vanderlaan ◽  
Anne Dunlop ◽  
Roger Rochat ◽  
Bryan Williams ◽  
Susan E. Shapiro
Keyword(s):  
Risk Factors ◽  
Administrative Data ◽  
Conventional Method ◽  
Maternal Morbidity ◽  
Sample Selection ◽  
Population Level ◽  
Risk Identification ◽  
Net Benefit ◽  
Maternal Risk ◽  
Risk Scoring

Abstract Background In population level studies, the conventional practice of categorizing women into low and high maternal risk samples relies upon ascertaining the presence of various comorbid conditions in administrative data. Two problems with the conventional method include variability in the recommended comorbidities to consider and inability to distinguish between maternal and fetal risks. High maternal risk sample selection may be improved by using the Obstetric Comorbidity Index (OCI), a system of risk scoring based on weighting comorbidities associated with maternal end organ damage. The purpose of this study was to compare the net benefit of using OCI risk scoring vs the conventional risk identification method to identify a sample of women at high maternal risk in administrative data. Methods This was a net benefit analysis using linked delivery hospitalization discharge and vital records data for women experiencing singleton births in Georgia from 2008-2012. We compared the value identifying a sample of women at high maternal risk using the OCI score to the conventional method of dichotomous identification of any comorbidities. Value was measured by the ability to select a sample of women designated as high maternal risk who experienced severe maternal morbidity or mortality. Results The high maternal risk sample created with the OCI had a small but positive net benefit (+ 0.6), while the conventionally derived sample had a negative net benefit indicating the sample selection performed worse than identifying no woman as high maternal risk. Conclusions The OCI can be used to select women at high maternal risk in administrative data. The OCI provides a consistent method of identification for women at risk of maternal morbidity and mortality and avoids confounding all obstetric risk factors with specific maternal risk factors. Using the OCI may help reduce misclassification as high maternal risk and improve the consistency in identifying women at high maternal risk in administrative data.

scholarly journals A study of maternal risk factors and the perinatal outcome in meconium stained amniotic fluid in central referral hospital

2019 ◽  
Vol 8 (11) ◽  
pp. 4146
Author(s):  
Kapil Singh Niranjan ◽  
Pesona Grace Lucksom
Keyword(s):  
Risk Factors ◽  
Amniotic Fluid ◽  
Perinatal Outcome ◽  
Significant Risk ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
Meconium Aspiration ◽  
Maternal Risk ◽  
Prolonged Labor ◽  
Meconium Stained Amniotic Fluid

Background: Meconium staining of amniotic fluid (MSAF) is a significant risk factor for the subsequent development of meconium aspiration syndrome (MAS), respiratory distress and eventual respiratory failure in neonates. To learn more about the risk factors and outcomes associated with MSAF, a prospective case control study was conducted. The objective of the study was to study various maternal risk factors associated with MSAF and to study the outcome of neonates born through MASF and to compare the perinatal outcome in patients with thick and thin meconium stained amniotic fluid.Methods: A hospital based prospective case control study was conducted comparing pregnant women with meconium stained (cases) amniotic fluid with pregnant women having clear liquor (control), 200 in each arm. Singleton pregnancies complicated with MASF were included in the cases group on the basis of predefined inclusion criteria. Various risk factors, mode of delivery, outcome of neonates and perinatal outcome in babies born through thick and thin meconium stained amniotic fluid was studied.Results: Out of 200 patients who had MSAF 114 patients (57%) had thick meconium stained liquor while remaining 86 patients (43.00%) had thin meconium stained amniotic fluid. Post-maturity, pregnancy induced hypertension; oligohydramnios and prolonged labor were found to be statistically significant risk factors for MSAF. Nonreactive non-stress test and Need for cesarean section was more common in women with MSAF as compared to women with clear liquor (p <0.05). Common morbidities in neonates were Birth asphyxia (15%) followed by meconium aspiration syndrome (10%) and hypoxic ischemic encephalopathy (15%).Conclusions: Meconium stained amniotic fluid is more commonly associated with post-maturity, pregnancy induced hypertension, oligohydramnios and prolonged labor low APGAR score and higher incidence of birth asphyxia and NICU admissions. Appropriate management of neonates with meconium aspiration syndrome is crucial to prevent neonatal mortality.

Clinical Presentation and Treatment of Amniotic Fluid Embolism

2018 ◽  
Vol 29 (3) ◽  
pp. 336-342 ◽  
Author(s):  
Anne-Marie McBride
Keyword(s):  
Amniotic Fluid ◽  
Clinical Presentation ◽  
Case Fatality ◽  
Fetal Distress ◽  
Fetal Tissue ◽  
Amniotic Fluid Embolism ◽  
Respiratory Compromise ◽  
Maternal Circulation ◽  
Average Case ◽  
Obstetric Emergencies

Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Diagnosis is by exclusion and clinical presentation. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Staff debriefing and psychological support for the woman and family are vital.

scholarly journals 331: Differences in clinical presentation and outcomes between women with typical versus atypical amniotic fluid embolism

2020 ◽  
Vol 222 (1) ◽  
pp. S223-S224
Author(s):  
Irene Stafford ◽  
Amirhossein Moaddab ◽  
Gary Dildy ◽  
Miranda Klassen ◽  
Alexandra Berra ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Clinical Presentation ◽  
Amniotic Fluid Embolism

scholarly journals Modern Management of Clinical Chorioamnionitis

1995 ◽  
Vol 3 (3) ◽  
pp. 123-132 ◽  
Author(s):  
Thomas Westover ◽  
Robert A. Knuppel
Keyword(s):  
Risk Factors ◽  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Morbidity And Mortality ◽  
Host Defenses ◽  
Detailed Review ◽  
Modern Management ◽  
Management Scheme ◽  
Maternal Morbidity And Mortality ◽  
Made In

Clinical chorioamnionitis continues to contribute to fetal and maternal morbidity and mortality. Significant advances have been made in the last 20 years in understanding the pathophysiologic processes leading to chorioamnionitis. This review addresses the history, incidence, pathophysiology, host defenses, risk factors, diagnosis, and maternal and neonatal management of clinically evident chorioamnionitis. After a detailed review of the physiologic processes leading to clinical chorioamnionitis and sepsis, we present a modern management scheme designed to optimize perinatal outcome for both mother and fetus.

scholarly journals Five-years review of obstetric hysterectomy at tertiary care center

2020 ◽  
Vol 10 (1) ◽  
pp. 308
Author(s):  
Anita G. Pawar ◽  
Mangala A. Shinde ◽  
Sarasjothi M. ◽  
Priyanka B. Nemagouda
Keyword(s):  
Risk Factors ◽  
Maternal Morbidity ◽  
Care Center ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Transfusion Rate ◽  
Hypertensive Disorder ◽  
Complication Rates ◽  
Tertiary Care Center ◽  
Maternal Morbidity And Mortality

Background: Obstetric hysterectomy (OH) is indicated as last resort operation to save the life of the mother  and associated with high complication rates, so  requires a highly experienced and skilled medical team ,to solve any complication. Objective was to identify incidence, demographic profile, indications, risk factors, complications, maternal morbidity and mortality associated   with   obstetric hysterectomy.Methods: Retrospective   analytical study of 47 case records is done over period of last 5 years   from October 1st October 2015 to 30th September 2020 at VDGIMS, a tertiary care center, Latur. Results are expressed in frequency and percentages.Results: In our study, the rate of OH was 1.1/1000 deliveries. Most common (68%) age group was 21-30 yrs, majority (70%) were multipara, and booked (76%). Most common indication of OH was atonic PPH (65%), followed by traumatic PP, including rupture uterus (21%), and placenta acreta (10%). Most OH was performed on emergency basis (91%) and of subtotal type (95%). Major mode of delivery  was cesarean 65% and vaginal delivery in 21% cases. Most common risk factors were placental causes (55%), previous LSCS (48%) and hypertensive disorder (31%). High maternal morbidity in form of 100% blood transfusion rate, 93% ICU admission, inotropes and ventilator support in 59% cases and prolonged hospital stay in 75% cases seen. Most common complication were hemorrhagic shock 21%, DIC (29%), renal failure (12%) and septic shock (14%) with maternal death rate of 23% was noted.Conclusions: Obstetric hysterectomy is a necessary life-saving operation, but also associated with high maternal morbidity and mortality, which can be minimized with timely done procedure by experienced person.

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