P Pu ur rp po os se e: : Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.C Co on nc cl lu us si io on ns s: : It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors. MNIOTIC fluid embolism (AFE) is a rare life-threatening complication unique to pregnancy. AFE has a mortality rate of 61 to 86% and accounts for approximately 10% of all maternal deaths in the United States. 1,2 AFE has a variable presentation, ranging from mild degrees of organ dysfunction to cardiovascular collapse, coagulopathy and death. 1,2 AFE usually presents at term during labour. 3 In this report, we present a patient in her second trimester of pregnancy who developed sudden hypoxic respiratory failure followed by cardiopulmonary arrest and coagulopathy following dilatation and evacuation (D & E) for intra-uterine fetal demise.
Objectif