Tips on Amniotic Fluid Embolism

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.

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Peripartum Embolism

10.1093/med/9780190226459.003.0046 ◽

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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Clinical Presentation and Treatment of Amniotic Fluid Embolism

AACN Advanced Critical Care ◽

10.4037/aacnacc2018419 ◽

2018 ◽

Vol 29 (3) ◽

pp. 336-342 ◽

Cited By ~ 3

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.

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

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.11.347 ◽

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

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Subclinical Amniotic Fluid Embolism Presenting as Sudden Onset Seizure Activity and Reintubation

The American Surgeon ◽

10.1177/000313482008600412 ◽

2020 ◽

Vol 86 (4) ◽

pp. 198-199

Author(s):

Philise Williams ◽

Jonathan Nguyen ◽

Michelle E. Duncan

Keyword(s):

Amniotic Fluid ◽

Seizure Activity ◽

Sudden Onset ◽

Amniotic Fluid Embolism ◽

Onset Seizure

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Primary Staphylococcus aureus Pericarditis

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v15i2.361 ◽

2020 ◽

Vol 15 (2) ◽

pp. 39-41

Author(s):

Haya Aziz ◽

Marc Bienz ◽

Abdullah Esmaiel ◽

George Thanassoulis

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Unusual Case ◽

Facteurs De Risque ◽

Prise En Charge ◽

Hematogenous Spread ◽

Pericardial Disease ◽

Bacterial Pericarditis ◽

Focus Of Infection ◽

Prompt Diagnosis

Bacterial pericarditis is a rare but fulminant disease that requires prompt diagnosis and management. It most commonly occurs from direct extension of an adjacent focus of infection or by hematogenous spread to the pericardium from more distant septic foci. Predisposing risk factors include immunosuppression, uremia, collagen vascular disease and thoracic surgery. We present the case of a 77-year-old gentleman with no previous pericardial disease who was diagnosed with primary Staphylococcus aureus pericarditis. The patient was treated with percutaneous pericardial effusion drainage and appropriate antibiotics resulting in complete resolution of his symptoms. This unusual case emphasizes that although it is frequently associated with significant morbidity and mortality, purulent pericarditis can present in a more indolent manner and in the absence of typical predisposing risk factors. ResumeLa péricardite bactérienne est une maladie rare mais fulgurante qui nécessite un diagnostic et une prise en charge rapides. Elle survient le plus souvent dans le prolongement direct d’un foyer infectieux adjacent ou par propagation hématogène au péricarde à partir de foyers septiques plus éloignés. Les facteurs de risque prédisposants sont l’immunosuppression, l’urémie, les maladies vasculaires du collagène et la chirurgie thoracique. Nous présentons le cas d’un homme de 77 ans, sans antécédents de maladie péricardique, chez qui on a diagnostiqué une péricardite primaire à Staphylococcus aureus. Le patient a été traité par un drainage percutané d’effusion péricardique et des antibiotiques appropriés, ce qui a permis de résoudre complètement ses symptômes. Ce cas inhabituel souligne que, bien qu’elle soit fréquemment associée à une morbidité et une mortalité importantes, la péricardite purulente peut se présenter de manière plus indolente et en l’absence de facteurs de risque prédisposants typiques.

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Effect of oral L- arginine versus intravenous hydration on maternal and fetal outcome in idiopathic oligohydramnios

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20211516 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1943

Author(s):

Suhail Iqbal ◽

Mehak Ayub Malik ◽

Heena Kaurani ◽

Divya Chauhan

Keyword(s):

Risk Factors ◽

Amniotic Fluid ◽

Gestational Age ◽

Perinatal Outcome ◽

Normal Growth ◽

Fetal Outcome ◽

Perinatal Morbidity ◽

Inclusion Criteria ◽

Amniotic Fluid Index ◽

Intravenous Hydration

Background: Adequate amount of amniotic fluid was required for normal growth of fetus. Oligohydramnios or reduced amount of amniotic fluid is associated with adverse maternal and perinatal outcome due to increase in induced labour and operative deliveries. Idiopathic oligohydramnios is a condition in which no other risk factors are associated with pregnancy. This study was done to compare the effect of L-arginine and IV hydration on improvement of amniotic fluid index and fetal growth.Methods: Total 50 patients were included in the study according to inclusion criteria and divided equally into two groups randomly. IV hydration was given to one group and other group received L- arginine sachet orally. The effect on AFI and fetal outcome was compared.Result: The result was compared with respect to age, gravidity, gestational age and AFI at the time of study and after giving treatment. Maternal and fetal outcome was compared which shows that L-arginine was more effective in increasing the AFI and thereby leading to favorable results in the form of increase in gestational age at time of delivery and fetal weight.Conclusion: This study shows that both IV hydration and L-arginine are useful in treatment of oligohydramnios. But L-arginine appears more advantageous over IV hydration in improving pregnancy outcome and reducing perinatal morbidity and mortality.

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