Embolia de líquido amniótico: Criterio diagnóstico en dos casos fatales / Amniotic fluid embolism: Diagnostic criteria in two fatal cases

La embolia de líquido amniótico continúa siendo una causa importante de mortalidad materna. Presentamos la información obtenida por medio de la cateterización cardíaca derecha y la ecocardiografía, en dos pacientes que desarrollaron embolia de líquido amniótico y fallecieron por shock y coagulación intravascular diseminada a pesar del tratamiento intensivo. Aunque la fisiopatología continúa siendo discutida, la embolia por líquido amniótico se puede diagnosticar y manejar a partir de los valores hemodinámicos y el ecocardiograma.

Amniotic fluid embolism still remains an important cause of maternal mortality. We present information obtained by echocardiography and right cardiac catheterization of two patients who developed amniotic fluid embolism and died from shock and disseminated intravascular coagulation despite intensive medical treatment. Although the pathophysiology remains controversial, amniotic fluid embolism can be presumptively diagnosed and managed with hemodynamic values and echocardiography.

Amniotic fluid embolism

Amniotic fluid embolism, although fortunately rare, is one of the most catastrophic situations in obstetrics. It cannot be predicted nor prevented. The clinical events in this syndrome include respiratory failure, cardiopulmonary collapse, and disturbances of the clotting mechanism. Maintenance of oxygenation, circulatory support and correction of the coagulopathy can be life saving. Although maternal and fetal prognosis is grave, death need not be the inevitable outcome if diagnosis is made early and is followed by prompt and aggressive management. Future efforts must be directed towards more clearly delineating the presentation, pathogenesis, diagnosis and outcome of amniotic fluid embolism