ABSTRACT
Amniotic fluid embolism is an obstetric complication that can present during pregnancy or labor and is associated with high rates of morbidity and mortality. The incidence is low but the mortality rates for both mother and fetus are high. A 34-year-old woman in the 41st week of gestation was admitted for induction of labor. While still in the labor room, she complained of pruritus around the mouth and tongue. Tonic-clonic convulsions, hypotension, and loss of consciousness followed. Cardiopulmonary resuscitation maneuvers were started and an immediate cesarean section under general anesthesia was performed to deliver a live infant boy. The Apgar score at 5 minutes was 8. The mother was transferred for recovery to the intensive care unit (ICU), where rapid cardiocirculatory and pulmonary decline continued. After 2 episodes of electromechanical dissociation, exitus occurred 2 hours after ICU admission. The autopsy confirmed the diagnosis of amniotic fluid embolism. Keratin squames were found in the capillaries of both lungs and polymorphonuclear cells and proteinaceous material were observed in alveoli. Mechanical obstruction is not the only cause of amniotic fluid embolism. Circulating substances that affect myocardial contractility and coagulation are also implicated and the cause may even be an allergic reaction. The usual signs are acute respiratory failure, cardiovascular collapse, and occasionally convulsions and coagulopathy. Cardiac arrest occurs in 80% of the cases. Treatment is symptomatic to provide life-sustaining measures in response to the clinical picture as it develops.
Subject(s)
Embolism, Amniotic Fluid , Adult , Embolism, Amniotic Fluid/diagnosis , Embolism, Amniotic Fluid/therapy , Fatal Outcome , Female , Humans , PregnancyABSTRACT
El embolismo de líquido amniótico (ELA) es una complicaciónobstétrica con una elevada morbimortalidadque puede presentarse tanto durante el embarazo comoen el parto. Su incidencia es escasa, mientras que tantola mortalidad materna como la fetal permanecen aúnmuy elevadas.Gestante de 34 años y 41 semanas que ingresa parainducción de parto. En la Sala de Dilatación nota pruritoen área peribucal y lengua y seguidamente convulsionestónico-clónicas, hipotensión y pérdida de consciencia.Se realizan maniobras de reanimación cardiopulmonare inmediatamente, bajo anestesia general, sepráctica una cesárea obteniéndose un recién nacido vivocon Apgar de 8 a los 5 minutos. En el postoperatorio setraslada a la paciente a UCI, donde prosigue el deteriorocardiocirculatorio y respiratorio, de manera rápidamenteprogresiva y, tras dos episodios de disociaciónelectromecánica, es éxitus a las 2 horas. La necropsiaconfirmó posteriormente el cuadro como ELA, encontrándoseláminas de queratina en la luz capilar deambos pulmones, con polimorfonucleares y materialproteináceo en la luz alveolar.Se sabe que el ELA no es consecuencia únicamente deuna obstrucción mecánica sino que influyen también unaserie de sustancias humorales liberadas que afectan a lacontractilidad miocárdica, a la coagulación, llegandoincluso a una reacción de hipersensibilidad. La clínicahabitual consiste en una insuficiencia respiratoria aguda,colapso cardiovascular y en ocasiones convulsiones y coagulopatíaque en el 80% de los casos desemboca en unaparada cardiaca. El tratamiento es sintomático y desoporte vital en función de la clínica predominante encada momento
Amniotic fluid embolism is an obstetric complicationthat can present during pregnancy or labor and is associatedwith high rates of morbidity and mortality. Theincidence is low but the mortality rates for both motherand fetus are high.A 34-year-old woman in the 41st week of gestationwas admitted for induction of labor. While still in thelabor room, she complained of pruritus around themouth and tongue. Tonic-clonic convulsions, hypotension,and loss of consciousness followed. Cardiopulmonaryresuscitation maneuvers were started and animmediate cesarean section under general anesthesiawas performed to deliver a live infant boy. The Apgarscore at 5 minutes was 8. The mother was transferredfor recovery to the intensive care unit (ICU), whererapid cardiocirculatory and pulmonary decline continued.After 2 episodes of electromechanical dissociation,exitus occurred 2 hours after ICU admission. Theautopsy confirmed the diagnosis of amniotic fluid embolism.Keratin squames were found in the capillaries ofboth lungs and polymorphonuclear cells and proteinaceousmaterial were observed in alveoli.Mechanical obstruction is not the only cause ofamniotic fluid embolism. Circulating substances thataffect myocardial contractility and coagulation are alsoimplicated and the cause may even be an allergic reaction.The usual signs are acute respiratory failure, cardiovascularcollapse, and occasionally convulsions andcoagulopathy. Cardiac arrest occurs in 80% of the cases.Treatment is symptomatic to provide life-sustainingmeasures in response to the clinical picture as it develops
