Embolismo de líquido amniótico durante el parto / Amniotic fluid embolism during delivery

El embolismo de líquido amniótico (ELA) es un cuadro extremadamente grave e infrecuente. Su pronóstico es fatal, tanto para la madre como para el feto. Incluso en los países desarrollados, donde se ha logrado disminuir la morbimortalidad de múltiples afecciones del embarazo, como la preeclampsia, continúa teniendo unas consecuencias devastadoras. A ello contribuye el desconocimiento que existe aún respecto a su fisiopatología, lo cual redunda en una mayor dificultad para su diagnóstico y tratamiento. Hoy día, el diagnóstico del ELA continúa siendo clínico y un diagnóstico de exclusión y, en muchas ocasiones, se hace tras la necropsia (AU)

Amniotic fluid embolism is an extremely serious and infrequent syndrome. Prognosis is fatal for the pregnant woman and the fetus. Even in developed countries, where morbidity and mortality from many disorders of pregnancy, such as preeclampsia, has decreased, amniotic fluid embolism still has catastrophic consequences. The pathogenesis of this syndrome remains unclear, increasing the difficulty of diagnosis and treatment. Currently, diagnosis of amniotic fluid embolism continues to be clinical and made on the basis of exclusion. On many occasions, diagnosis is made at autopsy (AU)

Ancillary studies in amniotic fluid embolism: a case report and review of the literature.

The incidence of amniotic fluid embolism during pregnancy is approximately 1/50,000 and has a mortality rate in excess of 80%. The postmortem diagnosis of amniotic fluid embolism can be challenging for forensic investigators and pathologists. At autopsy, usually signs of disseminated intravascular coagulation suggest an amniotic fluid embolism. A definitive diagnosis of amniotic fluid embolism cannot be made until ancillary studies are performed on the decedent's tissues. We report a case of a 37-year-old G3P2 white female who was 36 weeks gestation when her membranes spontaneously ruptured. She suddenly became breathless, went into cardiogenic shock, and died. The autopsy revealed gross and microscopic findings of amniotic fluid embolism, which was confirmed with ancillary studies consisting of special stains, immunohistochemistry, and a serum tryptase level. The authors hope this case report, including gross and microscopic autopsy findings with procedural and ancillary studies, and review of the literature will help investigators and pathologists in the diagnosis of amniotic fluid embolism.

Survival following amniotic fluid embolism and cardiac arrest complicated by sub-capsular liver haematoma.

We describe the anaesthetic and intensive care management of a 38-year-old mother with presumed amniotic fluid embolism who suffered cardiorespiratory collapse following delivery of a normal baby by caesarean section. After initial resuscitation, her recovery was complicated by development of disseminated intravascular coagulation and a large sub-capsular hepatic haematoma. We describe the initial resuscitative efforts and subsequent intensive therapy to full neurological recovery and discharge from hospital.

Recombinant factor VIIa after amniotic fluid embolism and disseminated intravascular coagulopathy.

This case report illustrates the successful use of activated recombinant factor VIIa in the management of severe postpartum hemorrhage secondary to amniotic fluid embolism.

Amniotic fluid embolism during caesarean section.

Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. A high index of clinical suspicion is necessary to make an early diagnosis to reduce morbidity and mortality. We report a non-fatal case of amniotic fluid embolism occurring during a caesarean section, with special emphasis on the mode of development and diagnosis. The initial presentation of this syndrome was a coagulopathy, followed by the usual complications of massive bleeding. Although non-specific, the diagnosis of amniotic fluid embolism was supported by the observation of amniotic fluid in the central venous blood as well as in the broncho-alveolar fluid.

[Fatal amniotic fluid embolism. Extraction by Caesarean section of a living child without neurological after-effects]. / Embolie de liquide amniotique rapidement fatale. Extraction par césarienne d'un enfant vivant sans séquelles neurologiques.

The authors report on the case of an amniotic fluid embolism, proven by post mortem, which was the result of an inaugural and irreversible cardiac arrest in a 37-year-old woman at 39 weeks of normal pregnancy. The Caesarean section was carried out as an extreme emergency in the labour room, while efforts were being made to resuscitate the mother, so as to deliver a living newborn without any neurological after-effects. The haemostatic consequences were showed up only on blood tests.

Coagulación intravascular diseminada: una complicación de la inducción del parto con prostaglandinas / Disseminated intravascular coagulation: a complication of labor induction with prostaglandin

Objetivos: Estudiar 12 casos de coagulación intravascular diseminada (CID), que se produjeron en relación con el uso de la prostaglandina E2 (PgE2) por vía endocervical para la inducción del parto. Sujetos y métodos: Durante el período transcurrido entre septiembre de 1995 y marzo de 2003, se practicaron 4.013 inducciones del parto con PgE2 intracervical en gestaciones a término. Los datos clínicos y los estudios de coagulación de la sangre fueron conclusivos para hacer el diagnóstico de CID. Resultados: La frecuencia de esta complicación es relativamente baja, 3 × 1.000 inducciones, pero su morbilidad es importante (50 por ciento de histerectomías).El marcador más significante de la discrasia sanguínea fueron los valores altos en suero del dímero D. El estudio anatomopatológico de las piezas extirpadas reveló una lesión del canal cervical en todos los casos. No hallamos evidencia de que el paso de líquido amniótico a la circulación sanguínea materna haya desencadenado la CID. Conclusión: Estos 12 casos de CID presentados después de la aplicación intracervical del gel de PgE2 se atribuyen al paso de factor tisular a la circulación sanguínea, o incluso a una respuesta inmunológica por el paso del mismo gel de prostaglandina a través del tejido epitelial al cervical. La posibilidad de que el líquido amniótico haya causado la CID se considera altamente improbable, y el éxito de la histerectomía (6 ocasiones) como recurso último para controlar la hemorragia, se añade en contra de la embolia de líquido amniótico como causa desencadenante (AU)

Fetal bradycardia and disseminated coagulopathy: atypical presentation of amniotic fluid emboli.

We present a parturient who developed an atypical case of amniotic fluid emboli presented by sudden fetal bradycardia, followed by maternal disseminated coagulopathy. The typical feature of cardiopulmonary collapse was absent in this patient implying that in some cases of amniotic fluid emboli (AFE), fetal hypoxia or acidemia is unrelated to maternal cardiopulmonary status.

Amniotic fluid embolism: an obstetric emergency.

AFE is an unpredictable, unpreventable, and, for the most part, an untreatable obstetric emergency. Management of this condition includes prompt recognition of the signs and symptoms, aggressive resuscitation efforts, and supportive therapy. Any delays in diagnosis and treatment can result in increased maternal and/or fetal impairment or death. Whereas once the invariable outcome of AFE was death of the mother, today the prognosis is somewhat brighter thanks to increased awareness of the syndrome and advances in intensive care medicine. In any case, intensive care nurses are called on to provide physical, life-saving care to the patient and her fetus. Both during and after the event, supportive care must be administered to the patient's family members, who are dealing with crisis and loss.

[Amniotic fluid embolism suspected in a case of seizure and mild uterine haemorrhage with activation of coagulation and fibrinolysis]. / Embolie amniotique d'évolution favorable suspectée devant un tableau clinique atypique.

After a normal pregnancy and labour in a 29-year-old parturient, a single seizure followed by a transient headache was observed during the uterine revision for placental retention. Mild uterine haemorrhage of 150 ml per hour without any uterine atony was associated with activation of clotting and fibrinolysis (decrease of fibrinogen, elevated fibrin soluble complexes and D-dimers). A ten fold value of foetal blood cells in maternal serum suggested the diagnosis of amniotic fluid embolism. Atypical forms of amniotic fluid embolism and their diagnosis are discussed.

Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization.

PURPOSE: To describe the anesthetic management of two cases of amniotic fluid embolus (AFE) and disseminated intravascular coagulation (DIC) who underwent bilateral uterine artery embolization to control their postpartum hemorrhage. CLINICAL FEATURES: We report the clinical course and management of two women who suffered sudden cardiorespiratory events during labour. The first patient had a cardiac arrest whereas the second developed respiratory failure and altered neurological status. They were diagnosed as having had an AFE. Both of these events were accompanied by severe postpartum hemorrhage and DIC. They suffered prolonged bleeding and received massive transfusions. Successful management of hemorrhage was optimized by uterine artery embolization, thus avoiding ongoing problems with bleeding and possible hysterectomy. The role of uterine artery embolization is described, along with its advantages and anesthetic considerations. CONCLUSION: Women with severe postpartum hemorrhage, with or without DIC, should be considered for uterine artery embolization.

Presumed antepartum amniotic fluid embolism.

BACKGROUND: Amniotic fluid embolism is seldom recognized in nonperipartum patients. The pathophysiology is uncertain and diagnosis imprecise, making management after stabilization difficult. CASE: A 37-year-old woman at 28 weeks' gestation presented with signs and symptoms consistent with amniotic fluid embolism including disseminated intravascular coagulopathy. A ventilation-perfusion scan demonstrated unmatched perfusion defects, but other radiographic studies were negative; the patient was treated with heparin. Four days after presentation she had spontaneous rupture of membranes followed by hypoxemia, necessitating cesarean delivery. A pulmonary arteriogram after the operation showed multiple filling defects; the patient was discharged on warfarin. CONCLUSION: Amniotic fluid embolism is a difficult diagnosis to make, at best. Anticoagulation may be a therapeutic option.

Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass.

BACKGROUND: Amniotic fluid embolism is a rare yet often lethal peripartum complication resulting from rapid cardiovascular collapse. Progress toward a better understanding of this entity has failed to identify either the underlying hemodynamic pathophysiology or an effective evidence-based treatment. CASE: A 45-year-old woman with a documented placenta previa experienced an amniotic fluid embolism during scheduled cesarean delivery. Transesophageal echocardiogram examination revealed catastrophic pulmonary vasoconstriction. The use of cardiopulmonary bypass, heparin, epinephrine, and high-dose steroids resulted in a successful outcome. CONCLUSION: Timely placement of transesophageal echocardiogram revealed catastrophic pulmonary vasoconstriction as the cause of circulatory collapse in a patient with amniotic fluid embolism, supporting the use of cardiopulmonary bypass as an effective intervention.

Amniotic fluid embolism with involvement of the brain, lungs, adrenal glands, and heart.

The case of a healthy 31-year-old woman in the 40th week of second pregnancy is presented. During preparation for an emergency caesarean section, she developed an amniotic fluid embolism (AFE) with unusual and unique features. The acute onset of disease with cardiorespiratory failure with hypotension, tachycardia, cyanosis, respiratory disturbances and loss of consciousness, suggested at first a pulmonary thromboembolism, but the appearance of convulsions led to the diagnosis of AFE. The patient died after 5 days due to an untreatable brain edema. At autopsy, AFE with the usually associated disseminated intravascular coagulation was found in the lungs, brain, left adrenal gland, kidneys, liver and heart. Eosinophilic inflammatory infiltrates were found in the lungs, hepatic portal fields and especially in the heart, suggesting a specific hypersensitivity reaction to fetal antigens. Moreover, intravascular accumulation of macrophages in the lungs also favored a non-specific immune reaction to amniotic fluid constituents.

Amniotic fluid embolism with haemostasis complications: primary fibrinogenolysis or disseminated intravascular coagulation?

Amniotic fluid embolism (AFE) is characterized by the passage of amniotic fluid (AF) into the maternal circulation during or just after childbirth. AFE is a rare disorder occurring in 1/8,000 to 1/80,000 deliveries but with a maternal morbidity ranging from 26% in a recent report to 86% in earlier ones. In patients who survive, AFE may affect coagulation resulting in severe bleeding. While disseminated intravascular coagulation (DIC) is usually seen in such cases, we reported a case of AFE in which the hemostatic abnormalities were compatible with primary fibrinogenolysis rather than with DIC.

Severe maternal respiratory distress due to the amniotic fluid embolism syndrome in a twin pregnancy.

A 28-year-old female with a twin pregnancy at 29 6/7 weeks who was having premature uterine contractions developed acute respiratory failure due to sudden pulmonary oedema requiring mechanical ventilation. No evidence for venous thromboembolism, pulmonary infection or myocardial infarction was found. Subsequently a mild coagulopathy and foetal distress developed. Ultrasonography revealed oligohydramnios of one of the foetuses. A Caesarean section was performed and postoperatively mother and babies had an uneventful clinical course. By exclusion of other causes, we diagnosed severe maternal acute respiratory distress due to the amniotic fluid embolism syndrome in a twin pregnancy.