Amniotic Fluid Embolism in Post Caesarean Section

Background: According to WHO, around 73% of maternal deaths globally are caused by direct obstetric causes. The amniotic fluid embolism is a life-threatening obstetric emergency characterized by sudden cardiopulmonary system failure and can be accompanied by Disseminated Intravascular Coagulation (DIC). The amniotic fluid embolism event usually occurs during labor and birth, but can also occur immediately in the post partum period or after pregnancy termination. About 56% of women will not survive for first 2 hours after the acute event. Amniotic fluid embolism is an unpredictable event, so that no prophylactic intervention can be carried out effectively and the handling and enforcement of a diagnosis that still debatable.Objective: To report maternal deaths due to amniotic fluid embolism post cesarean sectionMethod: Case ReportCase: Reported case of a 30 years old woman with an initial diagnosis in emergency departement with decreased consciousness due to Severe hypoxia due to Pulmonary emboli due to Amniotic fluid emboli on P2A0L2 post Cesarean Section first day of puerperium. The patient experienced a sudden loss of consciousness accompanied by severe shortness of breath after 6 hours after cesarean section surgery in a private hospital. After initial examination and treatment by administering oxygen through the Nonrebreathing Mask, there was no improvement in the O2 saturation value and then the patient was intubated by the anesthetist. After intubation, the O2 saturation value still does not increase, then the patient suddenly experiences cardiac arrest and followed with cardiac resuscitation for 2 cycles accompanied by resuscitation drugs then the patient returns to spontaneous circulation. From the cardiology department, inotropic therapy was given and echocardiographic investigations were carried out. On echocardiographic examination, they found McConnel's sign which showed suspicios of pulmonary embolism. At the time the patient will be moved to the intensive care unit, the patient experiences a cardiac arrest for the second time, then resuscitation is performed again for 2 cycles, but it does not work and the patient is declared dead.Conclusion: Amniotic fluid embolism is an obstetric emergency condition that cannot be predicted and has a high mortality rate. Treatment is supportive to support the cardiopulmonary system and management of coagulopathy that may occur.Keywords: maternal mortality, amniotic fluid embolism

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Amniotic Fluid Embolism in Post Caesarean Section

JOURNAL OBGIN EMAS ◽

10.25077/aoj.4.2.192-197.2020 ◽

2020 ◽

Vol 4 (2) ◽

pp. 192-197

Author(s):

Defrin Defrin ◽

Heri Farnas

Keyword(s):

Cardiac Arrest ◽

Cesarean Section ◽

Amniotic Fluid ◽

Pregnancy Termination ◽

Post Partum ◽

Amniotic Fluid Embolism ◽

Initial Examination ◽

Maternal Deaths ◽

Obstetric Emergency ◽

Cardiopulmonary System

BACKGROUND: According to WHO, around 73% of maternal deaths globally are caused by direct obstetric causes. The amniotic fluid embolism is a life-threatening obstetric emergency characterized by sudden cardiopulmonary system failure and can be accompanied by Disseminated Intravascular Coagulation (DIC). The amniotic fluid embolism event usually occurs during labor and birth, but can also occur immediately in the post partum period or after pregnancy termination. About 56% of women will not survive for first 2 hours after the acute event. Amniotic fluid embolism is an unpredictable event, so that no prophylactic intervention can be carried out effectively and the handling and enforcement of a diagnosis that still debatable.OBJECTIVE: To report maternal deaths due to amniotic fluid embolism post cesarean sectionMETHOD: Case ReportCASE: Reported case of a 30 years old woman with an initial diagnosis in emergency departement with decreased consciousness due to Severe hypoxia due to Pulmonary emboli due to Amniotic fluid emboli on P2A0L2 post Cesarean Section first day of puerperium. The patient experienced a sudden loss of consciousness accompanied by severe shortness of breath after 6 hours after cesarean section surgery in a private hospital. After initial examination and treatment by administering oxygen through the Nonrebreathing Mask, there was no improvement in the O2 saturation value and then the patient was intubated by the anesthetist. After intubation, the O2 saturation value still does not increase, then the patient suddenly experiences cardiac arrest and followed with cardiac resuscitation for 2 cycles accompanied by resuscitation drugs then the patient returns to spontaneous circulation. From the cardiology department, inotropic therapy was given and echocardiographic investigations were carried out. On echocardiographic examination, they found McConnel's sign which showed suspicios of pulmonary embolism. At the time the patient will be moved to the intensive care unit, the patient experiences a cardiac arrest for the second time, then resuscitation is performed again for 2 cycles, but it does not work and the patient is declared dead.CONCLUSION: Amniotic fluid embolism is an obstetric emergency condition that cannot be predicted and has a high mortality rate. Treatment is supportive to support the cardiopulmonary system and management of coagulopathy that may occur.KEYWORDS: Maternal mortality, Amniotic Fluid Embolism

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UTILIZATION OF POINT-OF-CARE ULTRASOUND AND ROTATIONAL THROMBOELASTOMETRY TO DIAGNOSE AND MANAGE AMNIOTIC FLUID EMBOLISM PRESENTING AS POST-PARTUM HEMORRHAGE AND CARDIAC ARREST

CHEST Journal ◽

10.1016/j.chest.2021.07.795 ◽

2021 ◽

Vol 160 (4) ◽

pp. A849

Author(s):

Angela Phillips ◽

David Tierney

Keyword(s):

Cardiac Arrest ◽

Amniotic Fluid ◽

Point Of Care ◽

Post Partum ◽

Amniotic Fluid Embolism ◽

Point Of Care Ultrasound ◽

Rotational Thromboelastometry ◽

Post Partum Hemorrhage

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Emboli Air Ketuban

Jurnal Anestesi Obstetri Indonesia ◽

10.47507/obstetri.v1i1.25 ◽

2020 ◽

Vol 1 (1) ◽

pp. 54-71

Author(s):

Ratih kumala fajar apsari ◽

Bambang Suryono Suwondo

Keyword(s):

Cardiac Arrest ◽

Amniotic Fluid ◽

Anaphylactoid Reaction ◽

Rare Complication ◽

Sudden Cardiac Arrest ◽

Multiple Organ ◽

Amniotic Fluid Embolism ◽

Maternal Deaths ◽

Acute Pulmonary Hypertension ◽

Symptoms And Signs

Emboli cairan amnion (EAK) adalah komplikasi kehamilan yang jarang namun membawa angka mortalitas yang tinggi. Patogenesis yang tepat dari kondisi ini masih belum diketahui. Emboli air ketuban (EAK) atau amniotic fluid embolism (AFE) atau anaphylactoid syndrome of pregnancy adalah salah satu komplikasi kehamilan yang paling membahayakan. Cairan ketuban, debris fetal diduga menyebabkan kolaps kardiovaskular dengan cara memicu reaksi imun/anafilaktoid maternal. Patofisiologi EAK hingga kini masih belum jelas tetapi diduga melibatkan kaskade immunologis. Kematian maternal bisa terjadi karena cardiac arrest mendadak, perdarahan karena koagulopati, dan kegagalan organ multipel dengan acute respiratory distess syndrome (ARDS). Gejala dan tanda EAK antara lain dispnea akut, batuk, hipotensi, sianosis, bradikardia fetal, ensefalopati, hipertensi pulmoner akut, koagulopati, dan sebagainya. Diagnosis EAK adalah bersifat klinis dan ditegakkan setelah menyingkirkan kemungkinan penyebab lain. Penatalaksanaan bersifat suportif dan memerlukan persalinan janin jika diperlukan, support respiratorik, dan support hemodinamik. Prognosis maternal setelah EAK masih sangat buruk meski tingkat survival janin sekitar 70%. Pasien dengan EAK paling baik dikelola di unit perawatan kritis oleh tim multidisiplin dan dengan manajemen supportif. Amniotic Fluid Embolism Abstract Amniotic fluid embolism (AFE) is a rare complication of pregnancy carrying a high mortality rate. The exact pathogenesis of the condition is still not known. Amniotic fluid embolism (AFE) or anaphylactoid syndrome of pregnancy is one of the most dangerous pregnancy complications. Amniotic fluid, fetal debris is thought to cause cardiovascular collapse by triggering a maternal immune / maternal anaphylactoid reaction. The pathophysiology of AFE remains unclear but is thought to involve an immunological cascade. Maternal deaths may occur due to sudden cardiac arrest, bleeding due to coagulopathy, and multiple organ failure with ARDS. AFE symptoms and signs include acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy. Management is supportive, respiratory support, and haemodynamic support. The maternal prognosis is very poor even though the survival rate of the fetus is about 70%. Patients with AFE are best managed in a critical care unit by a multidisciplinary team and management is largely supportive

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