Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report

Caeiro, A.F.; Ramilo, Irina; Santos, Ana Paula; Ferreira, Elizabeth Alves Gonçalves; Batalha, Isabel Santos

doi:10.1055/s-0037-1601428

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…There is insufficient data to reliably determine the risk in subsequent pregnancies. However, no cases of recurrent AFE have been published, while several cases of uneventful pregnancies in patients with prior AFE have been reported [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Acute ST-Elevation Myocardial Infarction During Labor Due to Amniotic Fluid Embolism

et al. 2022

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Patient: Female, 30-year-old Final Diagnosis: Amniotic fluid ambolism • disseminated intravascular coagulation • STEMI Symptoms: Cardiorespiratory arrest • convulsions • hemorrhage Medication: — Clinical Procedure: — Specialty: Anesthesiology • Cardiology • Obstetrics and Gynecology Objective: Rare disease Background: Amniotic fluid embolism (AFE) is an extremely rare, life-threatening complication of labor that leads to hyper-acute induction of inflammation and disseminated intravascular coagulation (DIC). Usually, acute pulmonary hypertension results in acute right ventricular failure, while DIC manifests by hemorrhagic and ischemic complications, ultimately leading to multi-organ failure and death. Case Report: A 30-year-old primigravida and primipara woman with no prior medical history was admitted for labor after intrauterine fetal death at 37 weeks of gestation. After medical birth induction, she had a convulsive seizure and cardiorespiratory arrest. Short mechanical resuscitation was performed before spontaneous circulation returned. Simultaneously occurring severe vaginal hemorrhage and an ST-elevation myocardial infarction (STEMI) triggered the diagnosis of AFE. Laboratory results fulfilled the criteria for DIC, and hemostatic resuscitation and mechanical hemostasis were performed. Transesophageal echocardiography revealed hypokinesia to akinesia of the inferior wall. Owing to the ongoing DIC, coronary angiography could not be performed. After the patient’s transfer to the Intensive Care Unit, ST-segment elevations resolved and the myocardial infarct was managed medically. Cardiac magnetic resonance imaging performed 3 months later demonstrated myocardial scarring in 2 different areas. Referring to the coronary artery anatomy in a computed tomography scan of the chest, the infarcted areas correlated with 2 different coronary supply territories. Conclusions: AFE should be considered in women with acute cardiorespiratory failure during labor. This is the first report of a STEMI triggered by an AFE. The 2 separate areas of infarction, corresponding to the 2 different coronary territories, suggest an AFE-related thrombotic/thromboembolic etiology.

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Section: Discussionmentioning

confidence: 99%

Acute ST-Elevation Myocardial Infarction During Labor Due to Amniotic Fluid Embolism

et al. 2022

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“…Respiratory failure as well as non-cardiogenic pulmonary edema should be among the possible subsequent complications of women surviving amniotic fluid embolism [18,24,50,25]. The risk of recurrence in future pregnancies is unknown.Although it cannot be accurately estimated, successful subsequent pregnancies reported in the literature support the attempt to achieve future pregnancies in women who have survived amniotic fluid embolism.The risk of recurrence in future pregnancies is unknown [51,52,53].…”

Section: Prognosismentioning

confidence: 99%

Amniotic fluid embolism: A rare and destructive obstetric complication

Thanasa¹,

Thanasa²,

Gerokostas³

et al. 2022

Magna Sci. Adv. Res. Rev.

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Amniotic fluid embolism is a rare, unpredictable and often catastrophic obstetric complication that usually occurs during labor or caesarean section. The pathogenetic mechanism has not been fully elucidated to date. Amniotic fluid embolism is believed to happen due to an anaphylactic reaction to embryonic antigens that enter the mother's circulation and trigger a variety of immune processes that produce an anaphylactic-like response. The diagnosis remains clinical. The disease manifests abruptly with cardiovascular shock, encephalopathy, fetal discomfort and disseminated intravascular coagulation. There is no special treatment. The treatment is supportive and focuses on rapid stabilization of the cardiopulmonary system, adequate oxygenation of the vital organs and correction of coagulation, ensuring the best possible perinatal outcome. In this article, based on current data, a literature review of this rare obstetric complication is attempted, particularly with regard to diagnosis and the basic treatment principles, the timely and correct application of which can provide the best possible outcome for the mother and the newborn.

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