ABSTRACT
Recommended management of patients with preeclampsia starts with a comprehensive clinical maternal and fetal evaluation, including maternal complete blood count, platelets, creatinine, LDH, liver enzymes, and urine test for proteinuria, along with fetal ultrasonographic evaluation and fetal antepartum testing.7 Subsequent management depends on the results of this evaluation and on gestational age. Continued observation is recommended for a woman with a preterm fetus if she has gestational hypertension or preeclampsia without severe features, until delivery at 37 weeks of gestation in the absence of abnormal antepartum testing, preterm labor, premature rupture of membranes, or vaginal bleeding.7 There are numerous conditions precluding such expectant management including severe hypertension refractory to treatment, persistent headaches refractory to treatment, epigastric or right upper pain refractory to treatment, visual disturbances, motor deficit, altered sensorium, stroke, myocardial infarction, new or worsening renal dysfunction, pulmonary edema, suspected acute placental abruption, vaginal bleeding in the absence of placenta previa, eclampsia, or HELLP syndrome.7.
ABSTRACT
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.
ABSTRACT
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.
