Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Tal Cahan ◽  
Hila De Castro ◽  
Anat Kalter ◽  
Michal J. Simchen
Keyword(s):  
Amniotic Fluid ◽  
Diagnostic Criteria ◽  
Clinical Presentation ◽  
Mode Of Delivery ◽  
Case Series ◽  
Amniotic Fluid Embolism ◽  
Published Data ◽  
Vacuum Extraction ◽  
Risk Pregnancy ◽  
Diagnostic Criterion

Abstract Objectives An international diagnostic criterion for amniotic fluid embolism (AFE) diagnosis has recently been published. Data regarding subsequent pregnancies is scarce. We sought to implement recent diagnostic criteria and detail subsequent pregnancies in survivors. Methods A case series of all suspected AFE cases at a tertiary medical center between 2003 and 2018 is presented. Cases meeting the diagnostic criteria for AFE were included. Clinical presentation, treatment, and outcomes described. Pregnancy outcomes in subsequent pregnancies in AFE survivors detailed. Results Between 2003 and 2018 14 women were clinically suspected with AFE and 12 of them (85.71%) met the diagnostic criteria for AFE. Three cases occurred during midtrimester dilation and evacuation procedures, and the remaining occurred in the antepartum period. Of the antepartum cases, mode of delivery was cesarean delivery or vacuum extraction for expedited delivery due to presentation of AFE in 8/9 cases (88.88%). Clinical presentation included cardiovascular collapse, respiratory distress and disseminated intravascular coagulopathy (DIC). Heart failure of varying severity was diagnosed in 75% (9/12) cases. Composite maternal morbidity was 5/12 (41.66%), without cases of maternal mortality. 11 subsequent pregnancies occurred in four AFE survivors. Pregnant women were followed by a high-risk pregnancy specialist and multidisciplinary team if pregnancy continued beyond the early second trimester. Six pregnancies resulted in a term delivery. No recurrences of AFE were documented. Conclusions Use of a diagnostic criterion for diagnosis of AFE results in a more precise diagnosis of AFE. Nevertheless, the accuracy of clinical diagnosis is still high. Subsequent pregnancies were not associated with AFE recurrence.

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

Midcavitary Tako-Tsubo syndrome in cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14011-e14011 ◽  
Author(s):  
Dana Ionescu ◽  
Danielle Stone ◽  
James Stone ◽  
Jean-Bernard Durand ◽  
Juan Lopez-Mattei ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Diagnostic Criteria ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Cancer Center ◽  
Published Data ◽  
Left Ventriculography

e14011 Background:Variants of the classic Tako-tsubo syndrome or stress induced cardiomyopathy (SC) includes mid ventricular or basal left ventricular wall motion abnormalities. Midcavitary dyskinesia and ballooning is considered a unique presentation, and there is no published data showing midcavitary involvement in cancer patients. Methods: All cancer patients who fulfilled the diagnostic criteria for SC at MD Anderson Cancer Center over a 6–year period were included in the study. We selected and retrospectively reviewed the medical records of 8 patients who had midcavitary SC. Clinical presentation, ECG, laboratory data, transthoracic echocardiogram and left ventriculography results were reviewed. Results: Out of30 cancer patients who fulfilled the diagnostic criteria for SC, 8 patients (26.7%) (4 females, 4 men, mean age 57.37 yo) had midcavitary SC. 62,5 % patients were diagnosed with a solid malignancy. Trigger factors for midcavitary SC were: systemic infection (3 patients with neutropenia), emotional stress (2 patients), chemotherapy (1 patient undergoing treatment with Ibrutinib), and surgical interventions (3 patients). Clinical presentation included chest pain (37.5%), shortness of breath (50%) and non specific symptoms (12.5%). T wave inversion was the most common electrocardiographic presentation (37.5 %), followed by ST elevation (25 %). All patients had changes of the cardiac biomarkers (BNP mean 2224. 4 pg/dl, TN I mean 2. 8 ng/dl, CK-MB mean 14 ng/dl) and significant LV dysfunction (LVEF < 50%). All patients underwent coronary angiography which showed no obstructive CAD; left ventriculography identified basilar and apical hyperkinesis and midventricular hypokinesia. Cancer therapy was interrupted; aspirin and beta blockers were initiated in all patients. The most common complications of midcavitary SC were: respiratory failure requiring intubation (37, 5%), pulmonary edema (25%), and hypotension (25%). No cardiac deaths were registered. None of the patients experienced recurrence of SC. Conclusions: Mid cavitary SC remains a rare entity, and raises further questions about the causal association between the mid cavitary involvement and cancer, and its impact on cancer therapy and overall survival in this cohort of patients.

scholarly journals Role of admission cardiotocography and amniotic fluid index on perinatal outcome in low risk pregnancy at term

2021 ◽  
Vol 10 (4) ◽  
pp. 1591
Author(s):  
Manasi Patnaik ◽  
Tejaswini M ◽  
Sudhanshu Kumar Rath ◽  
Shaik Afrah Naaz
Keyword(s):  
Amniotic Fluid ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Well Being ◽  
Low Risk ◽  
Amniotic Fluid Index ◽  
Risk Pregnancy ◽  
Low Risk Pregnancy

Background: Fetal surveillance even in normal or low risk pregnancy is essential to ensure safe parturition with minimum intervention. Cardiotocography (CTG) and clinical estimation of amniotic fluid volume (AFV) measured as amniotic fluid index (AFI) are two tests that are easily available in the labor room and can be used to identify fetal well-being. Our study aimed to evaluate role of admission cardiotocography (CTG) and amniotic fluid index (AFI) on perinatal outcome in low risk pregnancy at term.Methods: The study was conducted as a prospective observational study. All low risk pregnant women at term admitted to the labor ward in early or established labour between September 2018 and August 2020 were included in the study. They underwent admission CTG and AFI assessment using ultrasonography. All parameters including CTG changes, mode of delivery, AFI, presence of meconium, APGAR score at 1 and 5 mins, need for admission in neonatal ICU and perinatal mortality were recorded. Quantitative data was compared using chi square test.Results: A total of 180 patients were included in the study. Majority of the women belonged to the age group of 30-35 years. Abnormal CTG showing fetal distress was seen in 105 (58.33%) cases. Non-reactive CTG was significantly associated with meconium stained liqour, requirement for LSCS, still birth, fetal distress, APGAR <7 at 1 and 5min and NICU admission (p<0.001). The association of low AFI with non-reactive CTG had statistically significant impact on perinatal outcomes like low birth weight, requirement for LSCS, fetal distress, APGAR <7 at 1 and 5 mins and NICU admissions.Conclusions: Admission CTG is a simple non-invasive test that can serve as a screening tool in low risk obstetric population to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. Thus, it may help in preventing fetal morbidity and mortality.

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.

Presumed incipient choroidal melanoma: proposed diagnostic criteria and management

2021 ◽  
pp. bjophthalmol-2020-318658
Author(s):  
Susanna Jouhi ◽  
Ranaa T Al-Jamal ◽  
Martin Täll ◽  
Sebastian Eskelin ◽  
Tero T Kivelä
Keyword(s):  
Growth Rate ◽  
Diagnostic Criteria ◽  
De Novo ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Published Data ◽  
Basal Diameter ◽  
Long Term Follow Up ◽  
Uveal Melanomas

AimsTo propose diagnostic criteria for a presumed incipient choroidal melanoma based on tumour growth rate and tumour doubling time (TDT) and to describe management of such tumours with transpupillary thermotherapy (TTT).MethodsRetrospective interventional case series of nine consecutive presumed incipient uveal melanomas diagnosed and treated with TTT in 2010–2017. Growth rate in mm/year and per cent/year in largest basal diameter (LBD) and TDT were compared with published data for uveal melanomas and growing naevi that did not transform to melanoma under long-term follow-up.ResultsThe median LBD and thickness were 1.6 mm (range 0.9–2.3) and 0.20 mm (range 0.15–0.29), respectively. The median age was 57 years (range 47–78). Seven tumours were classified as de novo melanomas and two as transformed naevi. The median time from first observation to diagnosis was 3.3 years (range 2.2–7.3), LBD growth rate 0.25 mm/year (range 0.11–0.72) and 34 per cent/year (range 10–1437), and TDT 609 days (range 97–1612). The estimates matched those reported for uveal melanoma (median TDT 521 days, 90th percentile 2192) and exceeded those for growing naevi (median growth rate 0.04 mm/year, 90th percentile 0.12; 1.1 per cent/year, 90th percentile 2.6). The predicted median age at de novo appearance was 51 years (range 32–63). No tumour grew after TTT during a median follow-up of 2.1 years (range 0.6–8.7).ConclusionsIn this series, relative growth rate and TDT best qualified as diagnostic criteria for an incipient choroidal melanoma. Too small for brachytherapy, they could be managed with TTT.

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.

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