Amniotic fluid embolism: A diagnostic dilemma

Kulshrestha, Ashish; Mathur, Megha

doi:10.4103/0259-1162.94789

Cited by 4 publications

(4 citation statements)

References 19 publications

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“… Bedside transesophageal echocardiography may aid early diagnosis by showing acute pulmonary vasoconstriction, right ventricular dilation, and a collapsed left ventricle with leftward deviation of the intraventricular septum. [ 38 39 ] However, rapid access to transesophageal echocardiography is probably not available in many obstetric units. …”

Section: Diagnosis[ 6 9 16 mentioning

confidence: 99%

Amniotic fluid embolism

Kaur

Bhardwaj

Kumar

et al. 2016

J Anaesthesiol Clin Pharmacol

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Amniotic fluid embolism (AFE) is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%.

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Section: Diagnosis[ 6 9 16 mentioning

confidence: 99%

Amniotic fluid embolism

Kaur

Bhardwaj

Kumar

et al. 2016

J Anaesthesiol Clin Pharmacol

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“…However, there is no direct evidence has been documented till today. 4 It is currently believed that the presence of fetal debris in the maternal circulation is merely evidence of fluid passage within the maternal circulation. The contribution, if any, of these fetal particles to the pathophysiology of AFE may be through the release of arachidonic acid metabolites at lung level, induced by the capillary damage of microemboli.…”

Section: Discussionmentioning

confidence: 99%

“…The contribution, if any, of these fetal particles to the pathophysiology of AFE may be through the release of arachidonic acid metabolites at lung level, induced by the capillary damage of microemboli. 4 Alternatively the symptoms are fairly vague and non-specific, that make the diagnosis presumptive.…”

Section: Discussionmentioning

confidence: 99%

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Successful Outcome of Amniotic Fluid Embolism Complicated with Severe Postpartum Hemorrhage and Neurological Deficit

Oo¹,

Affendi²,

Aung³

2018

Journal of South Asian Federation of Obstetrics and Gynaecology

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An amniotic fluid embolism (AFE) is one of the rare obstetric emergency with a high maternal mortality rate. This condition is clinically characterized by three distinct phases: during the first phase, sudden onset of respiratory distress and cyanosis occur within seconds followed by hypotension, shock, and loss of consciousness within minutes. Of those who survive the initial insult, 40 to 50% enter the second phase characterized by coagulopathy and hemorrhage within hours. During the third phase, acute symptoms are over, and tissue injury of the brain, lung or renal is for the most part already established. The patient may succumb due to multisystem organ failure or infection acquired in the hospital.We report an interesting case of a middle-aged pregnant mother who developed AFE during the caesarean section and complicated with severe postpartum hemorrhage, which was successfully aborted by intramyometrial prostaglandin F2 alpha injection, thus obviating the need for hysterectomy. Following that she also suffered from expressive dysphasia and have an uneventful recovery through the speech therapy. We concluded that early diagnosis and timely intervention that may be the best way to achieve the favorable outcome of amniotic fluid embolism and intramyometrial prostaglandin is the available simple drug for preventing a peripartum hysterectomy during amniotic fluid embolism.

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