1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Pulmonary embolism caused by ovarian vein thrombosis during cesarean section: a case report. JA Clin Rep 2018; 4:3. [PMID: 29457113 PMCID: PMC5804668 DOI: 10.1186/s40981-017-0142-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/25/2017] [Indexed: 12/18/2022] Open
Abstract
Background Ovarian vein thrombosis is a rare complication of pregnancy. The representative complaints of patients with ovarian vein thrombosis are abdominal pain and fever. In some cases, however, fatal pulmonary embolism may develop. We report a case of pulmonary embolism presenting with severe hypotension and loss of consciousness during cesarean section possibly caused by ovarian vein thrombosis. Case presentation A 25-year-old woman at 38 weeks 4 days of gestation was scheduled for repeat cesarean section. Her past history was unremarkable, and the progress of her pregnancy was uneventful. She did not experience any symptoms indicative of deep vein thrombosis. Cesarean section was performed under spinal anesthesia, and a healthy newborn was delivered. After removal of the placenta, she suddenly developed dyspnea, hypotension, and loss of consciousness with decreased peripheral oxygen saturation. Blood pressure, heart rate, and oxygen saturation recovered after tracheal intubation and mechanical ventilation with oxygen. Postoperative computed tomography revealed no abnormality in the brain or in the pulmonary artery, but a dilated right ovarian vein with thrombi, extending up to the inferior vena cava, was found. A diagnosis of pulmonary embolism caused by ovarian vein thrombosis was made, and heparin was administered. The tracheal tube was removed on the first postoperative day. Her postoperative course was uneventful, and she was discharged with no complications. Conclusion Fatal pulmonary embolism might be caused by ovarian vein thrombosis during cesarean section. Careful and continuous observation of the patient after delivery and prompt treatment are important.
Collapse
|
3
|
Umazume T, Hayasaka S, Kato F, Ishikawa S, Morikawa M, Minakami H. Sudden maternal hypoxemia during elective cesarean section in a woman with placenta previa. Clin Case Rep 2017; 5:1668-1671. [PMID: 29026569 PMCID: PMC5628217 DOI: 10.1002/ccr3.1142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/29/2017] [Accepted: 07/26/2017] [Indexed: 11/06/2022] Open
Abstract
There have been no reports regarding imaging‐documented bronchospasm in patients with amniotic fluid embolism (AFE). In a woman with scheduled cesarean section for placenta previa, transient bronchospasm and pulmonary hypertension were documented explaining a sudden drop in SpO2. Mild AFE was the most likely diagnosis in this patient.
Collapse
Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Satoshi Hayasaka
- Department of Anesthesia; Hokkaido University Hospital; Sapporo Japan
| | - Fumi Kato
- Department of Diagnositic and Interventional Radiology; Hokkaido University Hospital; Sapporo Japan
| | - Satoshi Ishikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Mamoru Morikawa
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Hisanori Minakami
- Department of Obstetrics; Hokkaido University Graduate School of Medicine; Sapporo Japan
| |
Collapse
|
4
|
Liao CY, Luo FJ. Amniotic Fluid Embolism with Isolated Coagulopathy: A Report of Two Cases. J Clin Diagn Res 2016; 10:QD03-QD05. [PMID: 27891406 DOI: 10.7860/jcdr/2016/21720.8615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/04/2016] [Indexed: 11/24/2022]
Abstract
Amniotic Fluid Embolism (AFE) is a catastrophic complication of pregnancy with high mortality rate. The most common clinical presentation is an abrupt onset of cardiopulmonary collapse. Here, we present an uncommon variant involving isolated disseminated intravascular coagulation that developed without antecedent cardiopulmonary disturbances. Both patients developed symptoms soon after delivery. Blood test was sent at 14 minutes postpartum for the second patient due to suspected amniotic fluid embolism. Fetal components were observed in the uterine veins of the lower uterine segments in both cases. Amniotic fluid embolism with disseminated intravascular coagulopathy typically progresses faster than disseminated intravascular coagulopathy associated with other causes and symptoms. It usually develops within two hours of delivery. Prompt recognition and treatment of this entity is crucial to survival.
Collapse
Affiliation(s)
- Chi-Yuan Liao
- Attending Physician, Department of Obstetrics and Gynecology, Mennonite Christian Hospital , Hualien, Taiwan
| | - Fuh-Jinn Luo
- Attending Physician, Department of Pathology, Mennonite Christian Hospital , Hualien, Taiwan
| |
Collapse
|