Acute Pulmonary Embolism by Amniotic Fluid – A Rare Complication of Perinatal Period That Should Not Be Forgotten

Abstract

Amniotic fluid embolism (AFE) is a diagnostically challenging type of pulmonary embolism that occurs when amniotic fluid enters maternal circulation during delivery or postpartum. This obstetric complication is very rare but characterized by high mortality rate. The main symptoms are dyspnea, cardiovascular collapse, disseminated intravascular coagulation (DIC) and even sudden cardiac death. The aim of the article is to draw attention to AFE as a rare but possible and catastrophic complication of perinatal period. The authors present a 28-year-old woman who was admitted to obstetric ward during the first stage of labour. The patient developed sudden deterioration of her medical state with acute respiratory distress symptoms. An emergency cesarean section was performed, complicated by excessive bleeding. After a detailed assessment of the patient’s condition and evaluation of the results of additional tests, we diagnosed AFE as the cause of the patient’s deterioration. Conclusions: The case study shows how unpredictable, unpreventable and dangerous is AFE. It is still one of the main causes of maternal deaths in developed countries. Four diagnostic criteria proposed by the Society for Maternal-Fetal Medicine (SMFM) may accelerate diagnosis. AFE as a medical emergency, requires immediate multidisciplinary response and aggressive treatment. The initial medical care may be facilitated by the application of the general guidelines recommended by SMFM. The case report also emphasizes the need for further research on this disease, in particular on early detection and prevention.

Association of the Kiwi OmniCup system with maternal and neonatal morbidity: A retrospective cohort study

“…The primary endpoints were composite variables of severe maternal and neonatal morbidity. Severe maternal morbidity was defined as the occurrence of at least one of the following outcomes: third‐ or fourth‐degree perineal lacerations, 9 refractory postpartum hemorrhage, 10 thrombotic events, amniotic fluid embolism, 11 admission to the intensive care unit, and maternal death. Severe neonatal morbidity was defined as the occurrence of at least one of the following outcomes: neonatal asphyxia requiring resuscitation or intubation, neonatal head and face injuries, neonatal fracture, and admission to the neonatal intensive care unit (NICU) for longer than 24 h 12 .…”

“…The primary endpoints were composite variables of severe maternal and neonatal morbidity. Severe maternal morbidity was defined as the occurrence of at least one of the following outcomes: third-or fourth-degree perineal lacerations, 9 refractory postpartum hemorrhage, 10 thrombotic events, amniotic fluid embolism, 11 admission to the intensive care unit, and maternal death. Severe neonatal morbidity was defined as the occurrence of at least one of the following outcomes: neonatal asphyxia requiring resuscitation or intubation, neonatal head and face injuries, neonatal fracture, and admission to the neonatal intensive care unit (NICU) for longer than 24 h. 12 All diagnosed diseases were recorded in our hospital discharge records, and procedures were performed according to the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10) criteria; observations of severe maternal and neonatal morbidity were also collected in strict accordance with this procedure.…”