Embolia de líquido amniótico asociada a paro cardiorrespiratorio recuperado y síndrome de Sheehan / Amniotic fluid embolism associated with recovered cardiac arrest and postpartum Sheehan's syndrome

Resumen La embolia de líquido amniótico es una condición catastrófica propia del embarazo que ocurre típicamente durante el parto o justo posterior a este, cuyo sustrato fisiopatológico no ha sido aclarado por completo. Se ha estimado, según cifras de los Estados Unidos, que su incidencia rondaría 1 por cada 12.953 partos, y en el Reino Unido 1 por cada 50.000 partos; sin embargo, estas cifras pueden ser imprecisas debido a que no existen una referencia ni un consenso respecto a los criterios diagnósticos, además de que el cuadro clínico se puede confundir con otras emergencias obstétricas. Se presenta el caso de una paciente sin antecedentes mórbidos que presenta un cuadro de embolia de líquido amniótico no fatal, caracterizado por un estado fetal no tranquilizador durante la inducción del trabajo de parto, seguido de un paro cardiorrespiratorio durante la cesárea de urgencia y la rápida y catastrófica aparición de signos clínicos de una coagulopatía de consumo grave. Se describen además las complicaciones posoperatorias y su manejo, entre ellas un síndrome de Sheehan y la aparición de convulsiones tónico-clónicas generalizadas con alteración de neuroimágenes.

Abstract Amniotic fluid embolism is a catastrophic pregnancy condition that typically occurs during or inmediately after delivery, and whose pathophysiological background has not been fully clarified. According to US records the incidence of amniotic fluid embolism could been around 1 for every 12,953 births and in the United Kingdom 1 for every 50,000 births, however these numbers may be imprecise because there is no gold standard as well as no consensus regarding the diagnostic criteria, in addition that the clinical presentation can be misdiagnosis with other obstetric emergencies. We present the clinical case of a patient without a morbid history who presents with a non-fatal amniotic fluid embolism, characterized by an non-reassuring fetal status during labor induction, followed by cardiorespiratory arrest during emergency cesarean section and the rapid and catastrophic appearance of clinical signs of a severe consumptive coagulopathy. Postoperative complications and their management are also described, including Sheehans syndrome and the appearance of generalized tonic-clonic seizures with impaired neuroimaging.

Amniotic fluid embolism: lessons for rapid recognition and intervention

Amniotic fluid embolism is a rare, often fatal complication of labor and delivery. The classic presentation is the sudden onset of a triad of clinical manifestations: hypoxia, hypotension and coagulopathy. Understanding of the syndrome as an immunologically mediated, complicated and often catastrophic maternal response to fetal or placental antigens is coming into focus. New treatments such as extracorporeal membrane oxygenation (ECMO) and better use of old treatments such as transfusion offer hope, but the condition is often rapidly fatal, so saving the maternal and fetal lives depends on rapid recognition of the syndrome. This series of three cases illustrates the clinical features enabling the rapid recognition needed for successful treatment of amniotic fluid embolism syndrome.

Analysis of risk factors for perinatal hysterectomy / 中国实用妇科与产科杂志

OBJECTIVE: To analyze the risk factors for peripartum hysterectomy.METHODS: Retrospectively analyze the clinical data of 36 cases of peripartum hysterectomy in Shijiazhuang Obstetrics and Gynecology Hospital from January2012 to December 2018. The impact factors for peripartum hysterectomy were divided into clinical characteristics and obstetric treatment capacity. The annual rates of peripartum hysterectomy were compared and the risk factors for peripartum hysterectomy were analyzed by multi-factor Logistic regression analysisRESULTS: The indications of 36 cases of peripartum hysterectomy were intractable postpartum hemorrhage. The causes of hysterectomy included placenta implantation,amniotic fluid embolism,uterine atony and secondary infection. The annual rate of peripartum hysterectomy decreased gradually due to the promotion of obstetric treatment capacity. The peripartum hysterectomy rate in 2018 decreased significantly（P<0.001,P<0.001,P=0.004,P=0.009）compared with that of 2012,2013,2014 and 2015. Multifactor Logistic regression analysis showed that cesearen-section scar was a risk factor for peripartum hysterectomy（OR=1.403,P=0.018）.CONCLUSION: The severity of disease results in peripartum hysterectomy. The reduction of the peripartum hysterectomy rate lies in the promotion of obstetric treatment capacity,including improving maternal health care,reducing obstetric complications and improving the timely and effective treatment of patients with postpartum hemorrhage.

Team process rescue in amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism(AFE)is a rare complication that threatens the maternal and fetal life.Early identification and initiation of the rapid response team(RRT)and the correct rescue protocol can improve the prognosis.Unnecessary obstetrical interventions should be avoided to reduce the risk of AFE.Medical center should make standardized rescue protocol for AFE and implement standardized treatment.Establishing a RRT to perform early identification and implementation of multidisciplinary treatment is the key to successful rescue.Periodic training and simulations can improve communication skills and comprehensive treatment capabilities in a team emergency.

Role of hysterectomy in management of amniotic fluid embolism / 中国实用妇科与产科杂志

Hysterectomy is the ultimate management option for uterine hemorrhage.If other less invasive methods are unable to control the life-threatening uterine bleeding in the management of amniotic fluid embolism,hysterectomy should be immediately performed.However,hysterectomy is not the primary ornecessary treatment in most cases and prophylactic hysterectomy should never be performed.The indications,techniques and perioperative management are discussed in the article.

Obstetric management of amniotic fluid embolism / 中国实用妇科与产科杂志

This paper focuses on the obstetric management of amniotic fluid embolism,including the problems of perimortem cesarean section,the use of contractions and the operation of obstetric hysterectomy,so as to optimize the outcome of patients and reduce the mortality.

Management of DIC and the controversy about usage of heparin in amniotic fluid embolism / 中国实用妇科与产科杂志

Disseminated intravascular coagulation(DIC)is one of the major etiologies behind the pathological change of amniotic fluid embolism(AFE).The depletion of coagulation factor and the damage of red blood cell were common manifestations of DIC,which can also promote the formation of pulmonary hypertension.Meanwhile,DIC is also the main reason of hemorrhage of AFE.The detection of DIC at an early stage facilitates the clinical diagnosis of AFE.Preventing procoagulants from getting into the maternal circulation and anticoagulant therapy may be profitable to prevent the deterioration of DIC.Heparin should be both employed at the stage of hypercoagulation and the early stage hypocoagulation.Simultaneously,the supplement of coagulation factor is also crucial.The change of coagulation function must be closely monitored.

Glucocorticoid use in amniotic fluid embolism / 中国实用妇科与产科杂志

This paper discussed the use of glucocorticoids in amniotic fluid embolism treatment by analyzing the pathophysiological basis of amniotic fluid embolism and the pharmacological effects of glucocorticoids,and expounded the viewpoints and controversial issues supporting the application of glucocorticoids in amniotic fluid embolism.The conclusion is that there is no evidence to support the conventional use of glucocorticoids in the treatment of amniotic fluid embolism,although there is theoretical basis.It is controversial to use or not use large doses of glucocorticoids.

Pulmonary hypertension caused by amniotic fluid embolism / 中国实用妇科与产科杂志

Positive cardiopulmonary resuscitation is a guarantee for successful rescue.To remove pulmonary hypertension as soon as possible is the key to successful treatment.Dobutamine and milrinone have the effect of strengthening the heart and expanding the pulmonary artery,which is the drug of first choice for treatment.

Interdisciplinary treatment for the amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism is a rare but extremely dangerous complication in pregnant women.Its pathogenic pathophysiological nature is an immune process of the mother.This cascade endogenous immune response can quickly cause multiple organ dysfunction of the mother.Therefore,the treatment for this disease requires a multi-disciplinary and close collaborative medical rescue team in order to ensure the maternal and fetal safety in China.

Fluid management of amniotic fluid embolism / 中国实用妇科与产科杂志

The effective fluid resuscitation and management can not only save time for subsequent treatment measures but also lay the foundation for correcting blood loss and coagulation dysfunction,which helps avoid organ damage due to volume disorder during the treatment of amniotic fluid embolism(AFE).Amniotic fluid embolism management includes three parts:the phase of controlling volume load in right heart failure to avoid aggravation of pulmonary edema,maintain hemodynamic stability,the fluid resuscitationin cycle support phasea and restrictive fluid resuscitation in DIC phase.

Differential diagnosis of amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism(AFE)is one of the leading causes of maternal mortality.Our understanding of its diagnosis,differential diagnosis and treatment is hampered by the nonspecific clinical manifestation and a lack of uniform definition.AFE is often overdiagnosed or missed in peripartum women.It makes great significance to improve perinatal outcomes through differential and early diagnosis of AFE.

Diagnostic criteria for amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism is a rare and se-rious pregnancy complication and is an important cause of maternal death.Up to now,amniotic fluid embolism still lacks a clear and unified diagnostic standard,and it is only an exclusion diagnosis based on the clinical manifestations such as pulmonary hypertension,hypoxemia,hypotension,and coagulation dysfunction before massive hemorrhage that cannot be explained during labor and within 30 minutes after delivery.It is not recommended that any laboratory diagnosis be used for the diagnosis or exclusion of AFE,but blood routine,coagulation function,blood gas analysis,electrocardiogram,myocardial enzyme spectrum,chest X-ray,echocardiography,thromboelastic diagram,and hemodynamic monitoring are helpful for the diagnosis,condition monitoring and treatment of amniotic fluid embolism.Early treatment can improve the prognosis,so for every case of sudden pulmonary hypertension,hypoxemia,hypotension,coagulation dysfunction and other maternal symptoms,the possibility of amniotic fluid embolism should be considered.For clinically highly suspected amniotic fluid embolism,treatment can be performed before a definite diagnosis.

Clinical manifestation and early identification of amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism(AFE)is a rare and extremely dangerous condition in obstetrics.Clinical manifestations can be divided into cardiopulmonary failure and coagulation dysfunction.The onset can be acute or slow.The main clinical manifestations include prodrome,cardiopulmonary failure,bleeding and coagulation disorder,systemic organ damage,and fetal distress etc.The earlier we identify the symptom,the earlier we can intervene and perform the treatment in order to reduce the mortality of AFE.

Epidemiological status and pathophysiological changes of amniotic fluid embolism / 中国实用妇科与产科杂志

Amniotic fluid embolism is a rare and catastrophic complication during pregnancy.This study combines the international clinical and experimental researches about amniotic fluid embolism in the past ten years,and analyzes the epidemiological characteristics and pathophysiological changes of amniotic fluid embolism.,aiming to complete the theory of amniotic fluid embolism and improve a program for prevention,diagnosis and treatment of the amniotic fluid embolism.

Challenges in the diagnosis and management of amniotic fluid embolism in pregnant women / 中国实用妇科与产科杂志

Amniotic fluid embolism(AFE)is a rare obstetric complication. Because of the rarity of this condition, most physicians have limited experience in the management of AFE. The purpose of this article is to provide clinicians with opinion that may improve the ability to make an early diagnosis,and to establish appropriate supportive treatment for patients suffering from AFE to improve maternal and fetal outcomes.

Prevention and treatment for amniotic fluid embolism in caesarean section / 中国实用妇科与产科杂志

Amniotic fluid embolism(AFE)is rare and the most catastrophic complication of pregnancy,and it is often life-threatening to pregnant women and fetus.AFE is not only a major cause of direct maternal mortality in developed countries,but also one of the top three main factors contributing to maternal mortality in China.Since caesarean section is one of the risk factors for AFE,we retrospectively reviewed articles and documents about AFE related to caesarean section in recent 10 years,and shared the opinions and experience in regard to diagnosis and prevention of AFE in caesarean section,especially the experience of multidisciplinary team work in the management of women with AFE,including the obsterics and anesthesia departments.

Embolismo de líquido amniótico / Amniotic fluid embolism

Resumen El embolismo de líquido amniótico es una complicación seria y potencialmente mortal del embarazo, la cual es considerada imprevenible e impredecible. La mayoría de los casos ocurren durante la labor de parto, sin embargo hasta un tercio ocurren en el postparto inmediato. Su presentación es abrupta y se cree se debe a una respuesta anormal ante el paso de tejido fetal a la circulación materna, a través del sitio de inserción de la placenta. Ante la ausencia de criterios diagnósticos establecidos o pruebas de laboratorio específicas, los signos y síntomas clásicos como hipoxia, hipotensión y coagulopatía, en ausencia de otra explicación, conforman el diagnóstico clínico. Estos deben ser rápidamente identificados y tratados por parte de un equipo multidisciplinario, con el fin de reducir la morbilidad y mortalidad materna.

Abstract Amniotic fluid embolism is a serious and life-threatening complication of pregnancy, it is considered unpreventable and unpredictable, most cases occur during labor, however up to a third occur in immediate postpartum, its presentation is abrupt and is believed to be due to an abnormal response to the passage of fetal tissue to maternal circulation through the insertion site of the placenta. Due to the lack of established diagnostic criteria or specific laboratory tests, classic signs and symptoms such as hypoxia, hypotension and coagulopathy, in the absence of another explanation, make up the clinical diagnosis, these must be quickly identified and treated by a multidisciplinary team, in order to reduce maternal morbidity and mortality.

An analysis on one emergent case of delayed amniotic fluid embolism complicated with acute pituitary crisis leading to difficult weaning / 中国中西医结合急救杂志

Amniotic fluid embolism (AFE) is a clinical syndrome caused by amniotic fluid suddenly going into the maternal blood circulation in the process of delivery, the incidence is extremely low, however, its mortality is relatively high; since its clinical manifestations lack specificities, misdiagnosis or overlook of its presence often occurs. In this article, 1 case of delayed amniotic fluid embolism complicated with pituitary crisis leading to difficulty in weaning mechanical ventilation was reported in order to improve the understanding of AFE.