Amniotic fluid embolism managed with success during labour: report of a severe clinical case and review of literature

Abstract

Amniotic fluid embolism or anaphylactoid syndrome of pregnancy is a life-threatening condition. Diagnosis is one of the exclusion. Its management is very difficult and requires quick management and cooperation of physicians from different specialties.

Venous thromboembolism

“…Since 70% of AFE events occur in labor and delivery, what would otherwise be an uncomplicated process can quickly become a complex and difficult resuscitation. 13,14,16 Initial management includes therapy similar to other significant embolic events. 14,15 The incidence of AFE is 1 in 800 to 1 in 8,000 with a high mortality, comprising the etiology of 10% of maternal deaths.…”

Responding to Amniotic Fluid Embolism

“…Medical and nursing staff members should quickly establish a large‐bore peripheral IV catheter, a central venous pressure catheter, a pulmonary artery catheter, and a peripheral arterial line. Gathering additional resources and manpower from the anesthesia and critical care staffs will help support the resuscitation team during this emergency 36,37 . Transthoracic or transesophageal echocardiography (TEE) is often necessary to evaluate cardiac function and to guide treatment, along with a 12‐lead ECG 3 .…”

“…In addition, cryoprecipitate contains both fibrinogen and fibronectin, which facilitate the removal of cellular and particulate matter from the blood via the reticuloendothelial (ie, the mononuclear phagocyte) system 33,42 . Thrombocytopenia can be treated with the administration of platelets 36 …”

“…Disseminated intravascular coagulation (DIC) is found in 83% of patients with AFE. Half of these patients may develop coagulopathy within four hours of the onset of the clinical symptoms 36 . Anesthesia personnel may use low‐dose heparin to slow the coagulation cascade and thus treat the consumptive coagulopathy, although this practice is controversial 15…”

Fruchtwasserembolie

“…Die Angaben zur Inzidenz der Fruchtwasserembolie schwanken in der Literatur in erheblichem Maße und werden mit 1:800-80.000 Geburten angegeben; in den Industrieländern muss die Inzidenz mit 1: 20.000-80.000 angenommen werden [22]. Die [20].…”