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 Sudden Maternal Death from Suspected Amniotic Fluid Embolism and a Dead Baby Delivered with Natal Teeth

2019 ◽  
Vol 8 (1) ◽  
pp. 54-56
Author(s):  
Faiza Kamran Ali ◽  
Feriha Fatima Khidri ◽  
Kamran Ali Shahani ◽  
Rafia Shah
Keyword(s):  
Pregnant Woman ◽  
Sudden Death ◽  
Amniotic Fluid ◽  
Medical Literature ◽  
Amniotic Fluid Embolism ◽  
Cardiovascular Collapse ◽  
Rare Presentation ◽  
Rare Finding ◽  
Natal Teeth ◽  
Obstetric Emergencies

Amniotic fluid embolism (AFE) is a rare presentation in obstetric emergencies that carries great risk for the life of both mother and fetus. It is usually characterized by sudden cardiovascular collapse, respiratory distress and disseminated intravascular coagulation. Here we present a case of sudden death of a pregnant woman due to suspected AFE. We also present a rare finding of natal teeth in her deceased baby, which along with reported AFE in the mother, is an unlikely event in the medical literature.

scholarly journals Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Shadi Rezai ◽  
Alexander C. Hughes ◽  
Tracy B. Larsen ◽  
Paul N. Fuller ◽  
Cassandra E. Henderson
Keyword(s):  
Case Report ◽  
Amniotic Fluid ◽  
Supportive Therapy ◽  
Case Fatality ◽  
Signs And Symptoms ◽  
Amniotic Fluid Embolism ◽  
Diagnostic Challenge ◽  
Patient Response ◽  
Treatment Regimens ◽  
Novel Approach

Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac.

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.

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.

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.

scholarly journals Diagnosis dan Tatalaksana Emboli Air Ketuban

2020 ◽  
Vol 3 (2) ◽  
pp. 119-128
Author(s):  
Dwiana Sulistyanti ◽  
Yusmein Uyun
Keyword(s):  
Amniotic Fluid ◽  
Basic Life Support ◽  
Life Support ◽  
Early Recognition ◽  
Advanced Life Support ◽  
Sudden Onset ◽  
Amniotic Fluid Embolism ◽  
Fetal Mortality ◽  
High Morbidity ◽  
Maternal Circulation

Emboli air ketuban merupakan sindrom katastrofik yang terjadi selama kehamilan dan persalinan atau segera setelah melahirkan. Emboli air ketuban adalah peristiwa masuknya air ketuban yang mengandung sel-sel janin dan material debris lainnya ke dalam sirkulasi maternal yang menyebabkan kolaps kardiorespirasi. Patofisiologinya sampai saat ini belum jelas. Ada tiga faktor utama yang menyebabkan masuknya air ketuban kedalam sirkulasi ibu yaitu robekan amnion dan korion, terbukanya vena ibu baik melalui vena-vena endoserviks, sinus venosus subplasenta atau akibat laserasi segmen bawah rahim serta adanya tekanan yang mendesak masuknya air ketuban kedalam sirkulasi ibu. Gambaran klinisnya sesak yang tiba-tiba, gagal nafas dan hipotensi yang diikuti oleh kolaps kardiovaskuler, DIC dan kematian. Emboli air ketuban mempunyai angka morbiditas dan mortalitas yang tinggi. Pengenalan dini dan diagnosis emboli air ketuban sangat penting untuk meningkatkan angka harapan hidup maternal maupun janin. Penatalaksanaan emboli air ketuban bersifat non spesifik dan suportif, yaitu meningkatkan oksigenasi, memperbaiki sirkulasi, dan memperbaiki koagulopati diikuti dengan prinsip-prinsip basic life support dan advanced life support, dengan fokus utama yaitu stabilisasi kardiopulmonal maternal secara cepat. Tujuan utama yang paling penting adalah mencegah bertambah beratnya hipoksia dan gagal organ yang lebih lanjut. Resusitasi cepat sangat diperlukan tergantung pada keadaan klinis pasien. Pasien dengan emboli air ketuban mempunyai prognosis yang sangat jelek. Sampai saat ini, sindroma ini tidak dapat diprediksikan atau dicegah. Dengan diagnosis awal yang baik, resusitasi cepat dan pendekatan multidisiplin yang baik akan meningkatkan prognosis, memperbaiki mortalitas dan morbiditas maternal maupun fetal. Diagnostic and Management of Amniotic Fluid Embolism Abstract Amniotic fluid embolism (AFE) is a catastrophic syndrome that occurs during pregnancy and childbirth or immediately after delivery. Amniotic fluid embolism is an event when amniotic fluid containing fetal cells and other debris enter the maternal circulation, which causes cardiorespiratory collapse. The pathophysiology is not yet clear. There are three main factors that cause the entry of amniotic fluid into the mother's circulation, i.e. tearing of the amnion and chorion, an opening of the maternal veins either through the endocervical veins, subplacental venous sinuses or due to laceration of the lower uterine segment and the pressure that forces the entry of amniotic water into the mother's circulation. The clinical features are sudden onset of breathlessness, respiratory failure and hypotension followed by cardiovascular collapse, DIC and death. Amniotic fluid embolism has high morbidity and mortality rates. Early recognition and diagnosis of amniotic embolism are very important to increase the life expectancy of both the maternal and the fetus. Management of amniotic fluid embolism is non-specific and supportive, namely increasing oxygenation, improving circulation, and improving coagulopathy followed by the principles of basic life support and advanced life support, with the main focus of rapid maternal cardiopulmonary stabilization. The main and most important goal is to prevent further progression of hypoxia and organ failure. Rapid resuscitation is necessary, depending on the clinical condition of the patient. Patients with amniotic fluid embolism have a very poor prognosis. Until recently, this syndrome could not be predicted or prevented. With a good initial diagnosis, rapid resuscitation and a good multidisciplinary approach will improve prognosis, improve maternal and fetal mortality and morbidity.

Sign in / Sign up

Export Citation Format

Share Document