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Kostelecky N, Loxas M, Multz R, Flanagan ME, Ahrendsen JT, Goldstein J. Amniotic Fluid Embolism: An Illustrated Report and Review of Literature. Am J Forensic Med Pathol 2024:00000433-990000000-00194. [PMID: 39018441 DOI: 10.1097/paf.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Nicolas Kostelecky
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Margarita Loxas
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel Multz
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Jared T Ahrendsen
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffery Goldstein
- From the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Oda T, Tamura N, Yata D, Oda-Kishimoto A, Itoh T, Kubota N, Suzuki Y, Kanayama N, Itoh H. A Case of Consumptive Coagulopathy Before Cardiopulmonary Failure in Amniotic Fluid Embolism and Review of Literature: A Perspective of the Latent Onset and Progression of Coagulopathy. Cureus 2024; 16:e55961. [PMID: 38601376 PMCID: PMC11004845 DOI: 10.7759/cureus.55961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Amniotic fluid embolism (AFE) induces cardiopulmonary insufficiency with consumptive coagulopathy. Previous studies reported that refractory coagulopathy has already advanced at the onset of maternal cardiovascular and/or respiratory symptoms. However, when the consumption of coagulation factors starts during the clinical course, AFE remains to be elucidated. We report an intrapartum AFE case of consumptive coagulopathy before dyspnea with hypotension developing during urgent cesarean delivery that was revealed by non-reassuring fetal heart rate tracing. The patient, a 42-year-old multiparous parturient, underwent induced labor after a premature rupture of membranes in week 39 of pregnancy. Coagulation screening was initially within the normal range. Fetal heart rate monitoring demonstrated bradycardia coincided with uterine tachysystole after three hours, which required urgent cesarean section with preoperative blood screening. The hemoglobin level was maintained at 129 g/L; however, the fibrinogen value reduced to 1.79 g/L with D-dimer elevation over 60 µg/mL. Ninety minutes later, she developed dyspnea with hypotension at suturing hysterotomy. At the end of surgery, her fibrinogen further decreased to below 0.3 g/L with prolonged prothrombin time. After vigorous intensive care, she was discharged without sequelae. Consumptive coagulopathy may initiate and progress before apparent cardiopulmonary symptoms in some AFE cases. Non-reassuring fetal heart rate tracing concomitant with abrupt uterine tachysystole and/or hypertonus may be an earlier time point for the detection and intervention of AFE-related coagulopathy.
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Affiliation(s)
- Tomoaki Oda
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Naoaki Tamura
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Daisuke Yata
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Ayako Oda-Kishimoto
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Toshiya Itoh
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Naohiro Kubota
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Yasuyuki Suzuki
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Naohiro Kanayama
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
- Department of Obstetrics and Gynecology, Fuji City General Hospital, Fuji, JPN
| | - Hiroaki Itoh
- Department of Obstetrics & Gynecology, Hamamatsu University School of Medicine, Hamamatsu, JPN
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Nivatpumin P, Lertkovit S. Case report: Maternal cardiac arrest at 12 hours postpartum. Heliyon 2024; 10:e23337. [PMID: 38148823 PMCID: PMC10750056 DOI: 10.1016/j.heliyon.2023.e23337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Maternal cardiac arrest is a rare occurrence. In this case report, we present a detailed account of a 37-year-old pregnant woman with preeclampsia with severe features who underwent cesarean delivery. The patient experienced dyspnea and hypoxia at 12 hours postpartum, leading to cardiac arrest in the maternity ward. Advanced cardiac life support measures, including 15 minutes of chest compressions, were performed until spontaneous circulation was restored. This study explores the underlying factors contributing to maternal cardiac arrest during the postpartum period. Additionally, it highlights the effective strategies employed by our multidisciplinary team in managing and resolving this critical medical event.
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Affiliation(s)
- Patchareya Nivatpumin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saranya Lertkovit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lim C, Tsung-Che Hsieh C, Lai SY, Chu YT, Chen M, Wu HH. Amniotic fluid embolism: A case report of good outcome with timely intensive multidisciplinary team involvement. Taiwan J Obstet Gynecol 2023; 62:921-924. [PMID: 38008517 DOI: 10.1016/j.tjog.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE Amniotic fluid embolism is one of the most serious pregnancy complications. It can cause sudden maternal collapse with high mortality and morbidity. We present a case report regarding the important of prompt decision making and multidisciplinary team work for management of amniotic fluid embolism to yield favorable maternal and neonatal outcome. CASE REPORT This is a 35-year-old, gravida 2, para 1, woman underwent labor induction at gestational age of 37 + 6 weeks due to elective induction. She had sudden facial cyanosis and shortness of breath right after artificial rupture of membrane. Prompt decision of urgent cesarean section, aggressive and timely massive blood transfusion and multidisciplinary team work had spared patient from extracorporeal membrane oxygenation placement and prolonged hospitalization. A male infant was born with Apgar score 3' -> 5' with estimate body weight of 2958 gm; he was hospitalized for 10 days and no other complications was found at follow up pediatric outpatient clinic. CONCLUSION One of the most dreadful, but rare pregnancy complications is amniotic fluid embolism (AFE). It can cause serious maternal and neonatal morbidity and mortality. Rapid recognition and multidisciplinary team management are essential to maternal and neonatal prognosis.
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Affiliation(s)
- Caroline Lim
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Taiwan
| | | | - Siew Yen Lai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Taiwan
| | - Yi-Tzu Chu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Taiwan
| | - Ming Chen
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Taiwan; Department of Genomic Medicine, Changhua Christian Hospital, Changhua 50046, Taiwan; Department of Research, Changhua Christian Hospital, Changhua 50006, Taiwan; Department of Obstetrics and Gynecology, College of Medicine and Hospital, National Taiwan University, Taipei 100225, Taiwan; Department of Biomedical Science, Dayeh University, Changhua 515006, Taiwan; Department of Medical Sciences, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Hsin-Hung Wu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Taiwan; Medical College, National Chung Hsing University, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan.
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Wiseman D, Simard C, Yang SS, Koolian M, Abenhaim HA, Lipes J. Echocardiography findings in amniotic fluid embolism: a systematic review of the literature. Can J Anaesth 2023; 70:151-160. [PMID: 36307749 DOI: 10.1007/s12630-022-02343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Amniotic fluid embolism (AFE) is a leading cause of obstetrical cardiac arrest and maternal morbidity. The pathogenesis of hemodynamic collapse is thought to be from right ventricular (RV) failure; however, there is a paucity of data documenting echocardiography findings in this population. We undertook a systematic review of the literature to evaluate the echocardiography findings in patients with AFE. SOURCES We retrieved all case reports and case series reporting AFE in Embase and MEDLINE from inception to 20 November 2021. Studies reporting AFE diagnosed by fulfilling at least one of three different proposed AFE criteria and echocardiography findings during hospitalization were included. Patient and echocardiographic data were retrieved, and univariate logistic regression analysis was performed for outcomes of interest. Bias was assessed using the Joanna Briggs Institute clinical appraisal tool for case series. PRINCIPAL FINDINGS Eighty publications reporting on 84 patients were included in the final review. Fifty-five out of 82 patients with data (67%) showed RV dysfunction, including 11/82 (13%) with biventricular dysfunction; 14/82 (17%) had normal systolic function. No data on RV or left ventricular function were reported for two patients. The presence of RV dysfunction on echocardiography was associated with cardiac arrest (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.39 to 9.67; P = 0.009), and a composite risk of cardiac arrest, maternal death or use of extracorporeal membrane oxygenation (OR, 3.86; 95% CI, 1.43 to 10.4; P = 0.007). A low risk of bias was observed in 15/84 (18%) cases. CONCLUSIONS Right ventricular dysfunction on echocardiography is a common finding in AFE and is associated with a high risk of cardiac arrest. The finding of RV dysfunction on echocardiography may help diagnose AFE and help triage the highest risk patients with AFE. STUDY REGISTRATION PROSPERO (CRD42021271323); registered 1 September 2021.
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Affiliation(s)
- Daniel Wiseman
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Camille Simard
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Stephen S Yang
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Division of Critical Care, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Maral Koolian
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Haim A Abenhaim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jed Lipes
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada.
- Division of Critical Care, Jewish General Hospital, McGill University, Montréal, QC, Canada.
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Ling Z, Zhang S, Ju H, Zhang J. Unexpected serum phosphorus lost in an amniotic fluid embolism patient. Clin Chim Acta 2023; 538:91-93. [PMID: 36384174 DOI: 10.1016/j.cca.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Serum phosphorus concentration reflects body energy equilibrium and functions of the kidney and the coagulation system. It is regulated by serum calcium concentration and parathyroid hormone (PTH). CASE REPORT We present a case of constant low concentrations of serum phosphorus in a 34-year-old female who was diagnosed with amniotic fluid embolism (AFE) and was continuously treated with extracorporeal membrane oxygenation (ECMO), continuous renal replacement therapy (CRRT) and blood component transfusion during an observational period of 11 days. CONCLUSION This case highlights that the release of inorganic phosphorus from platelets and plasma into the blood prompts PTH secretion. The administration of active vitamin D supplement and PTH antagonism should be considered to neutralize the negative regulatory effect of PTH on serum phosphorus and to benefit patients' recovery in the intensive care unit.
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Affiliation(s)
- Zhen Ling
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province 210029, China
| | - Shichang Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province 210029, China
| | - Huanyu Ju
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province 210029, China
| | - Jiexin Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province 210029, China.
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Mazza GR, Youssefzadeh AC, Klar M, Kunze M, Matsuzaki S, Mandelbaum RS, Ouzounian JG, Matsuo K. Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism. JAMA Netw Open 2022; 5:e2242842. [PMID: 36399343 PMCID: PMC9675004 DOI: 10.1001/jamanetworkopen.2022.42842] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Amniotic fluid embolism (AFE) is an uncommon pregnancy complication but is associated with high maternal mortality. Because of the rarity of AFE, associated risks factors and maternal outcomes have been relatively understudied. OBJECTIVE To examine the clinical, pregnancy, and delivery characteristics and the maternal outcomes related to AFE in a recent period in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined hospital deliveries from January 1, 2016, to December 31, 2019, from the Healthcare Cost and Utilization Project's National Inpatient Sample. MAIN OUTCOMES AND MEASURES The primary outcome was clinical, pregnancy, and delivery characteristics of AFE, assessed with a multivariable binary logistic regression model. The coprimary outcome was failure to rescue, defined as maternal mortality after AFE. Associations with other severe maternal morbidity indicators and failure to rescue per clinical and pregnancy characteristics were also assessed. RESULTS A total of 14 684 135 deliveries were examined, with AFE diagnosed in 880 women, corresponding to an incidence rate of 6.0 per 100 000 deliveries. The cohort-level median patient age was 29 years (IQR, 25-33 years). In a multivariable analysis, (1) patient factors of older age, Asian and Black race, Western US region, pregestational hypertension, asthma, illicit substance use, and grand multiparity; (2) pregnancy factors of placental accreta spectrum (PAS), placental abruption, uterine rupture, polyhydramnios, chorioamnionitis, preeclampsia, fetal growth restriction, and fetal demise; and (3) delivery factors of early gestational age, cervical ripening, cesarean delivery, operative delivery, and manual removal were associated with AFE. Among these characteristics, PAS had the largest association with AFE (adjusted odds ratio [aOR], 10.01; 95% CI, 7.03-14.24). When stratified by the PAS subtypes, more severe forms of PAS had a greater association with AFE (aOR for increta and percreta, 17.35; 95% CI, 10.21-28.48; and aOR for accreta, 7.62; 95% CI, 4.83-12.01). Patients who had AFE were more likely to have coagulopathy (aOR, 24.68; 95% CI, 19.38-31.44), cardiac arrest (aOR, 24.56; 95% CI, 17.84-33.81), and adult respiratory distress syndrome (aOR, 10.72; 95% CI, 8.09-14.20). The failure-to-rescue rate after AFE was 17.0% overall. However, the failure-to-rescue rate exceeded 30% when AFE co-occurred with other severe maternal morbidity indicators: 45.8% for AFE, cardiac arrest, and coagulopathy; 43.2% for AFE, shock, and cardiac rhythm conversion; and 38.6% for AFE, cardiac arrest, coagulopathy, and shock. The failure-to-rescue rate after AFE also exceeded 30% when AFE occurred in the setting of placental pathology: 42.9% for AFE and PAS and 31.3% for AFE and placental abruption. CONCLUSIONS AND RELEVANCE This contemporaneous, national-level analysis validated previously known risk factors for AFE and confirmed the dismal outcomes of pregnancy complicated by AFE. The association between PAS and AFE, which was not previously reported, warrants further investigation.
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Affiliation(s)
- Genevieve R. Mazza
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Ariane C. Youssefzadeh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Rachel S. Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Joseph G. Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
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Abstract
Simulation is a critical part of training for obstetric emergencies. Incorporation of this training modality has been shown to improve outcomes for patients and is now required by national accrediting organizations.
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Liguori C, Tamburrini S, Ferrandino G, Leboffe S, Rosano N, Marano I. Role of CT and MRI in Cardiac Emergencies. Tomography 2022; 8:1386-1400. [PMID: 35645398 PMCID: PMC9149871 DOI: 10.3390/tomography8030112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT provides consistent diagnostic support, mainly in suspected coronary disease in patients with a low or intermediate pre-test risk. Moreover, it can gain information in the case of cardiac involvement in pulmonary vascular obstructive disease. MRI, on the other hand, has a leading role in the condition of myocardial damage irrespective of the underlying inflammatory or stress related etiology. This article discusses how radiology techniques (CT and MRI) can impact the diagnostic workflow of the most common cardiac and vascular pathologies that are responsible for non-traumatic chest pain admissions to the Emergency Department.
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Yu YF, Cao YD. Effect of intraoperative cell rescue on bleeding related indexes after cesarean section. World J Clin Cases 2022; 10:2439-2446. [PMID: 35434071 PMCID: PMC8968603 DOI: 10.12998/wjcc.v10.i8.2439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obstetric hemorrhage is the leading cause of maternal mortality globally, especially in China. The key to a successful rescue is immediate and rapid blood transfusion. Autotransfusion has become an integral part of clinical blood transfusion, with intraoperative cell salvage (IOCS) being the most widely used.
AIM To investigate the application of IOCS in cesarean section.
METHODS A total of 87 patients who underwent cesarean section and blood transfusion in our hospital from March 2015 to June 2020 were included in this prospective controlled study. They were divided into the observation (43 cases) and control (44 cases) groups using the random number table method. The patients in both groups underwent lower-segment cesarean section. The patients in the control group were treated with traditional allogeneic blood transfusion, whereas those in the observation group were treated with IOCS. Hemorheology [Red blood cell count, platelet volume, and fibrinogen (FIB)] and coagulation function (partial prothrombin time, prothrombin time (PT), platelet count, and activated coagula-tion time) were measured before and 24 h after transfusion. In the two groups, adverse reactions, such as choking and dyspnea, within 2 h after cesarean section were observed.
RESULTS Before and after transfusion, no significant differences in hemorheology and coagulation function indices between the two groups were observed (P > 0.05). About 24 h after transfusion, the erythrocyte count, platelet ratio, and FIB value significantly decreased in the two groups (P < 0.05); the PLT value significantly decreased in the two groups; the activated partial thromboplastin time, PT, and activated clotting time significantly increased in the two groups (P < 0.05); and no statistical differences were observed in hemorheology and coagulation function indices between the two groups (P > 0.05). Furthermore, there was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).
CONCLUSION In patients undergoing cesarean section, intraoperative cell salvage has a minimum effect on hemorheology and coagulation function and does not increase the risk of amniotic fluid embolism.
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Affiliation(s)
- Yu-Fang Yu
- Department of Blood Transfusion, Hai’an People’s Hospital Affiliated to Nantong University, Hai’an 226600, Jiangsu Province, China
| | - Yong-Dong Cao
- Department of Clinical Laboratory, Hai’an Qutang Central Health Center, Hai’an 226600, Jiangsu Province, China
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Wu Y, Luo J, Chen T, Zhan H, Liu J, Chen J, Wang S. Successful ECMO-assisted open chest cardiopulmonary resuscitation in a postpartum patient with delayed amniotic fluid embolism. Eur J Med Res 2022; 27:19. [PMID: 35115037 PMCID: PMC8815117 DOI: 10.1186/s40001-021-00628-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background Amniotic fluid embolism (AFE) is a rare but potentially dangerous severe obstetrics complication, which is accompanied by an incidence between 1.9 and 6.1 per 100,000 births. Case presentation Here, we report an AFE case after cesarean delivery diagnosed on a cardiac arrest complicated by acute respiratory distress syndrome and coagulopathy. Diagnosis, risk factors and pathophysiology for AFE have been fully discussed, besides, extracorporeal membrane oxygenation in the early management of cardiac arrest was used, describing the indication, efficacy and successful performed of open-chest cardiopulmonary resuscitation for the patient. Conclusion In AFE with cute cardiovascular collapse, extracorporeal membrane oxygenation support can be considered as the alternative therapies. The rare but dangerous amniotic fluid embolish after cesarean delivery was diagnosed. A cardiac arrest accompanied by acute respiratory distress syndrome and coagulopathy was recorded. Diagnosis, risk factors and pathophysiology for amniotic fluid embolish in this case were detailly discussed.
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Affiliation(s)
- Yafen Wu
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Jin Luo
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Tao Chen
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Hong Zhan
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Jinfa Liu
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Junxing Chen
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Shouping Wang
- Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China.
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Abstract
We present a patient with sudden cardiovascular collapse during cesarean delivery that was attributed to amniotic fluid embolism (AFE). The syndrome of AFE may be initiated by an anaphylactoid response to amniotic fluid in the maternal circulation that triggers the release of pulmonary vasoconstrictors, with transient pulmonary vasospasm, causing hemodynamic collapse and profound left ventricular failure. Milrinone, a pulmonary vasodilator used in the management of emergent right ventricular failure, was administered via a nebulizer in an effort to decrease pulmonary vascular resistance. If used immediately after AFE, inhaled milrinone may mitigate pulmonary vasoconstriction, providing a bridge to extracorporeal membrane oxygenation.
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Simard C, Yang S, Koolian M, Shear R, Rudski L, Lipes J. The role of echocardiography in amniotic fluid embolism: a case series and review of the literature. Can J Anaesth 2021; 68:1541-1548. [PMID: 34312822 DOI: 10.1007/s12630-021-02065-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/03/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Amniotic fluid embolism (AFE) is a rare, but often fatal condition characterized by sudden hemodynamic instability and coagulopathy occurring during labour or in the early postpartum period. As the mechanisms leading to shock and the cardiovascular effects of AFE are incompletely understood, the purpose of this case series is to describe how AFE presents on echocardiography and review limited reports in the literature. CLINICAL FEATURES We describe three cases of AFE at the Jewish General Hospital, a tertiary care centre in Montreal, Canada. All cases met the Clark diagnostic criteria, which comprise 1) sudden cardiorespiratory arrest or both hypotension and respiratory compromise, 2) disseminated intravascular coagulation, 3) clinical onset during labour or within 30 min of delivery of the placenta, and 4) absence of fever. Two patients had a cardiac arrest and the third developed significant hypotension and hypoxia. In all patients, point-of-care echocardiography at the time of shock revealed signs of right ventricular failure including a D-shaped septum, acute pulmonary hypertension, and right ventricular systolic dysfunction. CONCLUSION This case series and literature review of AFE emphasizes the importance of echocardiography in elucidating the etiology of maternal shock. The presence of right ventricular failure may be considered an important criterion to diagnose AFE.
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Affiliation(s)
- Camille Simard
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Stephen Yang
- Division of Critical Care, Department of Medicine, Jewish General Hospital, McGill University, 3755 ch. de la Côte-Sainte-Catherine Rd, Suite H-364.1, Montreal, QC, H3T 1E2, Canada
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maral Koolian
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Roberta Shear
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lawrence Rudski
- Azrieli Heart Center, Jewish General Hospital, Montreal, QC, Canada
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jed Lipes
- Division of Critical Care, Department of Medicine, Jewish General Hospital, McGill University, 3755 ch. de la Côte-Sainte-Catherine Rd, Suite H-364.1, Montreal, QC, H3T 1E2, Canada.
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Dupuis N, Connan L, Boisson-Gaudin C, Parant O, Guerby P. [Spontaneous amniotic fluid embolism during the second trimester of pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:215-217. [PMID: 32615161 DOI: 10.1016/j.gofs.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 06/11/2023]
Affiliation(s)
- N Dupuis
- Pôle Femme-Mère-Couple, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31300 Toulouse, France
| | - L Connan
- Pôle Femme-Mère-Couple, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31300 Toulouse, France
| | - C Boisson-Gaudin
- Service de biochimie, UF biologie fœto-maternelle, centre de biologie et pathologie Est, CHU de Lyon HCL, 69677 Bron, France
| | - O Parant
- Pôle Femme-Mère-Couple, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31300 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France
| | - P Guerby
- Pôle Femme-Mère-Couple, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31300 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France.
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15
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Cerebrovascular events during pregnancy and puerperium. Rev Neurol (Paris) 2021; 177:203-214. [PMID: 33642057 DOI: 10.1016/j.neurol.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Abstract
Though cerebrovascular complications of pregnancy remain relatively rare, they represent a potentially devastating event that necessitates prompt identification and treatment. Eighteen percent of strokes occurring in young women are linked to pregnancy. They occur mostly in the third trimester or during the post-partum period. Their biggest risk factors are hypertension, preeclampsia/eclampsia and migraine. Cerebrovascular events occurring during this period may involve specific pathophysiological processes that include embolic phenomena or endothelial dysfunction, but can also have common etiologies that are simply favored by the context of pregnancy. Thus, posterior encephalopathy and vasoconstriction cerebral syndrome are relatively frequently involved in cerebrovascular complications of pregnancy. Other very specific causes like amniotic fluid embolism or postpartum cardiomyopathy can also be responsible for such events. The management of stroke during pregnancy must be multidisciplinary and include a neurovascular expertise. Some conditions can lead to a long-life follow-up and modify the management of a future pregnancy.
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Orlowski MH, Soares WE, Kerrigan KA, Zerden ML. Management of Postabortion Complications for the Emergency Medicine Clinician. Ann Emerg Med 2020; 77:221-232. [PMID: 33341294 DOI: 10.1016/j.annemergmed.2020.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023]
Abstract
Although induced abortion is generally a safe outpatient procedure, many patients subsequently present to the emergency department, concerned about a postabortion complication. It is helpful for emergency physicians to understand the medications and procedures used in abortion care in the United States to effectively and efficiently triage and treat women presenting with potential complications from an abortion. Furthermore, because many states are experiencing increased abortion restrictions that limit access to care, emergency medicine physicians may encounter more patients presenting after self-managed abortions, which presents additional challenges. This article reviews the epidemiology and background of abortion care, including the range of symptoms and adverse effects that are within the scope of an uncomplicated procedure. This review also offers a comprehensive overview of management of abortion complications, including algorithms for more common complications and descriptions of less common but more severe adverse events. The article concludes with a recognition of the social stigma and legal regulations unique to abortion care.
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Affiliation(s)
| | - William E Soares
- University of Massachusetts Medical School at Baystate Medical Center, Springfield, MA
| | - Kathleen A Kerrigan
- University of Massachusetts Medical School at Baystate Medical Center, Springfield, MA
| | - Matthew L Zerden
- Planned Parenthood South Atlantic, Chapel Hill, and WakeMed Health & Hospitals, Raleigh, NC
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17
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Hasan N, McGrath M, Cortes G, Miller J, Deck C. A Case Report on Managing Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome) During a Rapid Response Code. Cureus 2020; 12:e11028. [PMID: 33214956 PMCID: PMC7671296 DOI: 10.7759/cureus.11028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a relatively rare condition that can complicate pregnancies. We present a 31-year-old gravida 5 para 0 female at 37-3/7 weeks gestation who presented with sudden onset severe epigastric pain, shortness of breath, diaphoresis, bradycardia, and elevated blood pressure. A Rapid Response Team (RRT) was called, and the patient was treated with IV magnesium in addition to blood pressure control medications. Laboratory results confirmed the diagnosis of HELLP syndrome. HELLP syndrome has the potential for major thrombotic complications and should be considered. Early consideration and evaluation of thrombotic complications amongst other common diagnoses are important for prompt treatment and optimization of maternal and fetal well-being.
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Affiliation(s)
- Nida Hasan
- Obstetrics and Gynecology, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, USA
| | - Margaret McGrath
- Obstetrics and Gynecology, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, USA
| | - Gillean Cortes
- Medicine, A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, USA
| | - Jacob Miller
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Charles Deck
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
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18
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Wu HD, Song ZK, Cao HY, Xu XY, Tang ML, Yang S, Liu Y, Qin L. Successful treatment of amniotic fluid embolism complicated by disseminated intravascular coagulation with rivaroxaban: A case report. Medicine (Baltimore) 2020; 99:e18951. [PMID: 31977912 PMCID: PMC7004698 DOI: 10.1097/md.0000000000018951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
RATIONALE An amniotic fluid embolism (AFE) is a rare, lethal syndrome that is commonly associated with disseminated intravascular coagulation (DIC). Anticoagulation therapy is the most important strategy to inhibit excessive activation of the coagulation cascade in patients with AFE and DIC. At present, treatment of AFE with rivaroxaban has not been reported. PATIENT CONCERNS We report a 37-year-old woman (gravida 2, para 1) at 39 weeks' gestation with irregular contractions of the uterus was admitted to the obstetrical department. Ten minutes after the spontaneous rupture of the membranes, the patient complained of dyspnea and dysphoria and exhibited cyanosis of her lips. The patient's blood pressure decreased and heart rate increased rapidly, and 2100 mL of unclotted blood flowed from her vagina within 1 hour. Her platelet count dropped to 21 × 10/L, and the results from routine coagulation tests, and D-dimer and fibrin degradation product tests were obviously abnormal. DIAGNOSES According to the current research consensus, AFE with DIC should be considered immediately when sudden cardiovascular collapse occurs around the time of labor and delivery, followed by the development of coagulopathy and hemorrhage. INTERVENTIONS In addition, the variety of supportive treatments, rivaroxaban was used in anticoagulant therapy. OUTCOMES At follow-up 30 and 60 days, there were no complaints of discomfort or abnormal laboratory assays. The patient recovered completely. LESSONS This case highlights that rivaroxaban, as a direct inhibitor of activated factor Xa, demonstrates a good therapeutic efficacy for treating AFE with DIC.
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Bernstein SN, Cudemus-Deseda GA, Ortiz VE, Goodman A, Jassar AS. Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section. N Engl J Med 2019; 381:1664-1673. [PMID: 31644848 DOI: 10.1056/nejmcpc1904046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sarah N Bernstein
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Gaston A Cudemus-Deseda
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Vilma E Ortiz
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Annekathryn Goodman
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
| | - Arminder S Jassar
- From the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Massachusetts General Hospital, and the Departments of Obstetrics and Gynecology (S.N.B., A.G.), Anesthesia (G.A.C.-D., V.E.O.), and Surgery (A.S.J.), Harvard Medical School - both in Boston
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20
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Abstract
Many health care providers lack familiarity with maternal physiologic changes and the distinctive underlying etiology of cardiac arrest in pregnancy. Knowledge of what changes are expected in pregnancy and an understanding of how to adapt clinical practice is essential for the care of the pregnant woman in the emergency department. Amniotic fluid embolism should be recognized as a rare cause of cardiac arrest in pregnancy, characterized by the triad of cardiovascular collapse, hypoxic respiratory failure, and coagulopathy. Cardiopulmonary resuscitation should follow standard AHA ACLS guidelines. Resuscitative hysterotomy may be attempted to restore perfusion to both mother and fetus.
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Affiliation(s)
- Philippa N Soskin
- Department of Emergency Medicine, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Georgetown University School of Medicine, 3800 Reservoir Road Northwest, Ground Floor CCC Building, Washington, DC 20007, USA
| | - Jennifer Yu
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, 110 Irving Street Northwest, Suite 4B-42, Washington, DC 20010, USA.
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21
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Zizzo M, Mengoli MC, Zanelli M, Marco LD, Lococo F, Ugoletti L, Pedrazzoli C. Atypical presentation of amniotic fluid embolism in liver and colon. Korean J Intern Med 2019; 34:227-230. [PMID: 29936778 PMCID: PMC6325436 DOI: 10.3904/kjim.2018.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Correspondence to Maurizio Zizzo, M.D. Surgical Oncology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia 42123, Italy Tel: +39-0522-296372 Fax: +39-0522-295779 E-mail:
| | - Maria Cecilia Mengoli
- Pathology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Magda Zanelli
- Pathology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Loredana De Marco
- Pathology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Filippo Lococo
- Thoracic Surgery Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Lara Ugoletti
- Surgical Oncology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Claudio Pedrazzoli
- Surgical Oncology Unit, Department of Oncology and Advanced Technologies, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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22
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Bouchè C, Wiesenfeld U, Ronfani L, Simeone R, Bogatti P, Skerk K, Ricci G. Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage. Ther Clin Risk Manag 2018; 14:1671-1675. [PMID: 30254448 PMCID: PMC6140737 DOI: 10.2147/tcrm.s150049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background/aim Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population. Patients and methods A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively. Results A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95% CI: 1.2-1.5, p<0.001 and OR=2.5, 95% CI: 1.5-4.2, p<0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95% CI: 1.0-2.2, p=0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal-perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates. Conclusion To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.
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Affiliation(s)
- Carlo Bouchè
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Uri Wiesenfeld
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Luca Ronfani
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Roberto Simeone
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy,
| | - Paolo Bogatti
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Kristina Skerk
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy,
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy, .,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy,
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23
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Metodiev Y, Ramasamy P, Tuffnell D. Amniotic fluid embolism. BJA Educ 2018; 18:234-238. [PMID: 33456838 DOI: 10.1016/j.bjae.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Y Metodiev
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - P Ramasamy
- University Hospitals of Leicester NHS Trust, Leicester, UK
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24
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Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
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Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
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25
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Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen. Case Rep Obstet Gynecol 2017; 2017:8458375. [PMID: 29430313 PMCID: PMC5753013 DOI: 10.1155/2017/8458375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/26/2017] [Accepted: 11/19/2017] [Indexed: 01/08/2023] Open
Abstract
Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac.
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26
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Kobayashi H, Akasaka J, Naruse K, Sado T, Tsunemi T, Niiro E, Iwai K. Comparison of the Different Definition Criteria for the Diagnosis of Amniotic Fluid Embolism. J Clin Diagn Res 2017; 11:QC18-QC21. [PMID: 28892982 DOI: 10.7860/jcdr/2017/26746.10283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/24/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are several sets of criteria for the diagnosis of Amniotic Fluid Embolism (AFE), but little is known about their degree of agreement. AIM To evaluate the concordance of the Japan criteria for AFE in comparison with two definitions: the US AFE registration entry criteria (the US criteria) and UK Obstetric Surveillance System criteria for defining cases of amniotic fluid embolism (the UK criteria). MATERIALS AND METHODS A retrospective observational study was conducted in which the AFE cases registered in the Obstetrical Gynaecological Society of Kinki District in Japan for the period of April 2005 to December 2012 have been analysed by the expert steering obstetric committee, organized by the members of the Obstetric Research group. Cohen's kappa coefficient was used to calculate the agreement among three clinical diagnoses. For inter-group comparison, the Pearson Chi-square test was used (for categorical) and Mann-Whitney test was used (for continuous variables). RESULTS Among the 26 cases registered for this period, a total of 18 women were selected as having AFE according to the Japan criteria. Five women died (case fatality rate 27.8%). Agreement between the Japan criteria and the US and UK criteria was k = 0.453 and k = 0.538, respectively, reflecting moderate agreement. However, only 38.9% were given a diagnosis of AFE according to all three criteria. The factor that most often caused disagreement in diagnosis between the Japan criteria and the US criteria was "onset within 30 minutes postpartum". The UK criteria excluded "women with postpartum haemorrhage as the first presenting feature in whom there was no evidence of cardiorespiratory compromise". The case fatality rates in US and UK are higher than in Japan (50.0% and 38.5% vs 27.8%), but this did not result in a significant difference (p=0.497). CONCLUSION The groups of subjects identified as having AFE by the Japan criteria had a medium agreement with the US (k=0.453) or UK criteria (k=0.538). These three definition criteria identified different subgroups of patients. Such disagreement has serious implications for research and treatment.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
| | - Juria Akasaka
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
| | - Katsuhiko Naruse
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
| | - Toshiyuki Sado
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
| | - Taihei Tsunemi
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
| | - Emiko Niiro
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
| | - Kana Iwai
- Department of Obstetrics and Gynaecology, Nara Medical University, Nara, Japan
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