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Araki H, Sekino M, Hasegawa Y, Kurobe M, Motokawa T, Tanigawa A, Egashira T, Iwasaki N, Suzumura M, Yano R, Matsumoto S, Ichinomiya T, Higashijima U, Kanayama N, Miura K, Hara T. Amniotic fluid embolism rescued using venoarterial extracorporeal membrane oxygenation without initial anticoagulation: A case report and literature review. Medicine (Baltimore) 2024; 103:e38176. [PMID: 38758915 PMCID: PMC11098262 DOI: 10.1097/md.0000000000038176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
RATIONALE Amniotic fluid embolism (AFE) is a fatal obstetric condition that often rapidly leads to severe respiratory and circulatory failure. It is complicated by obstetric disseminated intravascular coagulation (DIC) with bleeding tendency; therefore, the introduction of venoarterial extracorporeal membrane oxygenation (VA-ECMO) is challenging. We report the case of a patient with AFE requiring massive blood transfusion, rescued using VA-ECMO without initial anticoagulation. PATIENTS CONCERNS A 39-year-old pregnant patient was admitted with a complaint of abdominal pain. An emergency cesarean section was performed because a sudden decrease in fetal heart rate was detected in addition to DIC with hyperfibrinolysis. Intra- and post-operatively, the patient had a bleeding tendency and required massive blood transfusions. After surgery, the patient developed lethal respiratory and circulatory failure, and VA-ECMO was introduced. DIAGNOSIS Based on the course of the illness and imaging findings, the patient was diagnosed with AFE. INTERVENTIONS By controlling the bleeding tendency with a massive transfusion and tranexamic acid administration, using an antithrombotic ECMO circuit, and delaying the initiation of anticoagulation and anti-DIC medication until the bleeding tendency settled, the patient was managed safely on ECMO without complications. OUTCOMES By day 5, both respiration and circulation were stable, and the patient was weaned off VA-ECMO. Mechanical ventilation was discontinued on day 6. Finally, she was discharged home without sequelae. LESSONS VA-ECMO may be effective to save the lives of patients who have AFE with lethal circulatory and respiratory failure. For safe management without bleeding complications, it is important to start VA-ECMO without initial anticoagulants and to administer anticoagulants and anti-DIC drugs after the bleeding tendency has resolved.
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Affiliation(s)
- Hiroshi Araki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Motohiro Sekino
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuri Hasegawa
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaya Kurobe
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsufumi Motokawa
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Tanigawa
- Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan
| | - Takashi Egashira
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Iwasaki
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Miki Suzumura
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Rintaro Yano
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sojiro Matsumoto
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Taiga Ichinomiya
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ushio Higashijima
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Suissa N, Czuzoj-Shulman N, Abenhaim HA. Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States. Eur J Obstet Gynecol Reprod Biol 2024; 294:92-96. [PMID: 38219609 DOI: 10.1016/j.ejogrb.2023.12.034] [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: 08/25/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE To estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. STUDY DESIGN Population-based retrospective cohort study using the 2000-2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. RESULTS Over the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40-10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. CONCLUSION AFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates.
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Affiliation(s)
- Naomi Suissa
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.
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Young BK, Florine Magdelijns P, Chervenak JL, Chan M. Amniotic fluid embolism: a reappraisal. J Perinat Med 2024; 52:126-135. [PMID: 38082418 DOI: 10.1515/jpm-2023-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/20/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Using cases from our own experience and from the published literature on amniotic fluid embolism (AFE), we seek to improve on existing criteria for diagnosis and discern associated risk factors. Additionally, we propose a novel theory of pathophysiology. METHODS This retrospective case review includes eight cases of AFE from two hospital systems and 21 from the published literature. All cases were evaluated using the modified criteria for research reporting of AFE by Clark et al. in Am J Obstet Gynecol, 2016;215:408-12 as well as our proposed criteria for diagnosis. Additional clinical and demographic characteristics potentially correlated with a risk of AFE were included and analyzed using descriptive analysis. RESULTS The incidence of AFE was 2.9 per 100,000 births, with five maternal deaths in 29 cases (17.2 %) in our series. None of the cases met Clark's criteria while all met our criteria. 62.1 % of patients were over the age of 32 years and two out of 29 women (6.9 %) conceived through in-vitro fertilization. 6.5 % of cases were complicated by fetal death. Placenta previa occurred in 13.8 %. 86.2 % of women had cesarean sections of which 52.0 % had no acute maternal indication. CONCLUSIONS Our criteria identify more patients with AFE than others with a low likelihood of false positives. Clinical and demographic associations in our review are consistent with those previously reported. A possible relationship between cesarean birth and risk of AFE was identified using our criteria. Additionally, we propose a new hypothesis of pathophysiology.
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Affiliation(s)
- Bruce K Young
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York City, USA
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, USA
| | | | - Judith L Chervenak
- Department of Obstetrics and Gynecology, Bellevue Medical Center, New York City, USA
| | - Michael Chan
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, USA
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Wang Y, He J, Zhang X, Zhang G. Confusion in the monitoring of coagulation function in pregnant and neonate patients with severe disease: A case reports and brief literature review. Medicine (Baltimore) 2023; 102:e35997. [PMID: 37986357 PMCID: PMC10659726 DOI: 10.1097/md.0000000000035997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Different populations have their own unique physiological and pathological characteristics. However, in specialized maternal and child hospitals, there is currently a lack of standardized methods for assessing coagulation dysfunction, both domestically and internationally. PATIENT CONCERNS A 19-day-old neonate was transferred to neonatal intensive care unit with cyanosis, nasal bleeding for 6 hours, and a consciousness disorder for 5 hours. A 33-year-old woman presented with hydramnios and a 39 + 3week intrauterine pregnancy. All indicators before delivery were normal, but postpartum hemorrhage occurred after delivery. DIAGNOSES We retrospectively analyzed 1 neonate with pulmonary hemorrhage accompanied by thrombocytopenia and 1 pregnant patient with amniotic fluid embolism. INTERVENTIONS The new coagulation indicators, such as thrombin-antithrombin complex, plasmin-alpha 2 antiplasmin complex, thrombomodulin, and tissue plasminogen activator-plasminogen activator inhibitor-1 complex, have been indicated to be valuable. In neonates, it is necessary to continuously monitor special items combined with specific therapeutic agents, such as tranexamic acid. In cases where postpartum hemorrhage occurs with low fibrinogen levels, it is essential to effectively identify patients with severe amniotic fluid embolism from a high incidence of specimen clotting. OUTCOMES The neonate's oxygen saturation stabilized, and after 5 days of treatment with low molecular weight heparin, thrombin-antithrombin complex and plasmin-alpha 2 antiplasmin complex returned to normal levels. The pregnant began to remove the remaining thrombus, the patient's condition recovered, and she had a good prognosis. LESSONS For pregnant and neonatal critical illnesses, it is necessary to develop personalized coagulation monitoring programs that provide realistic and reasonable treatment recommendations. Such programs should consider the unique physiological and pathological characteristics of different populations to ensure effective management of critically ill patients.
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Affiliation(s)
- Yuefang Wang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Jiajing He
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Xia Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
| | - Ge Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, People’s Republic of China
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Nasrullah A, Herrera M, Garbinski A, DuMont T, Alhajhusain A. Medical Emergencies in the Pregnant Patient. Crit Care Nurs Q 2023; 46:403-416. [PMID: 37684736 DOI: 10.1097/cnq.0000000000000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
This review article provides a comprehensive overview of common medical emergencies that can occur in pregnant patients. We summarize the key diagnostic and management steps for each emergency to assist health care professionals in identifying and treating these potentially life-threatening conditions. The medical emergencies discussed in this article include postpartum hemorrhage; hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; acute fatty liver of pregnancy; amniotic fluid embolism; pulmonary embolism; acute respiratory distress syndrome; and shock. Each condition is described in detail, with a focus on the clinical presentation, diagnostic workup, and treatment options. The information presented in this review article is based on current best practices and guidelines from leading medical organizations. We hope this article will serve as a valuable resource for health care professionals who care for pregnant patients and help improve outcomes for these patients in emergency situations.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, Pennsylvania
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Shaikh N, Alhammad MF, Nahid S, Umm E A, Fatima I, Ummunnisa F, Yaqoub SA. Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound. Qatar Med J 2023; 2023:13. [PMID: 37521090 PMCID: PMC10376761 DOI: 10.5339/qmj.2023.13] [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] [Received: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Pregnant patients are at risk of several possible complications during the peripartum period. Amniotic fluid embolism (AFE) is a peripartum complication with high mortality and morbidity. The sudden entry of amniotic fluid into the maternal circulation causes a rapid and dramatic sequence of clinical events called AFE. The reported incidence of AFE after a cesarean section is around 19%, and after a normal delivery, it is 11%. AFE causing multiple embolisms is not reported in the literature, nor is the use of point-of-care ultrasound (POCUS) in the diagnosis of AFE. We report a case of AFE causing pulmonary and ovarian embolisms. CASE A 34-year-old pregnant lady had an elective lower section cesarean section (LSCS) for transverse lying and placenta previa under combined spinal and epidural anesthesia. She was gravida 3 para 2 and had regular antenatal check-ups, and she presented for her LSCS at 36 weeks of gestation. Immediately after delivery of the fetus, the patient had convulsions, cardiac arrest, and disseminated intravascular coagulopathy (DIC). Immediately, cardiopulmonary resuscitation started, and the team achieved a return of spontaneous circulation (ROSC) in 3 minutes. DIC was corrected with blood and blood products during this maneuver, and POCUS of the inferior vena cava and heart showed multiple small particles floating, thus confirming the diagnosis of AFE in this patient. The patient was transferred to the intensive care unit (ICU), intubated, and ventilated, necessitating a vasopressor infusion. Computed tomographic pulmonary angiography (CTPA) showed pulmonary embolism and ovarian vein embolism, which were managed with heparin infusion. She was hemodynamically stable and weaned from vasopressors, and the ventilator was then extubated on day 13 of ICU admission. She remained awake and in stable condition. The patient was transferred to the ward and subsequently discharged to go home on the 20th-day post-delivery. CONCLUSION AFE can be quickly diagnosed using clinical manifestations and POCUS, and it can be managed early for better patient outcomes. POCUS will show multiple smaller and a few larger amniotic fluid emboli in the heart and vena cava. These larger AFE emboli can migrate and cause multiple embolisms, requiring systemic anticoagulation.
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Affiliation(s)
- Nissar Shaikh
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Muhammad Fras Alhammad
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Seema Nahid
- Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: ORCID ID: https://orcid.org/0000-0002-8241-7939
| | - Amara Umm E
- Apollo Medical College Hyderabad, Telangana, India
| | - Ifrah Fatima
- The University of Missouri-Kansas City (UMKC), Missouri, USA
| | | | - Slawa Abu Yaqoub
- Women's Wellness & Research Center, Hamad Medical Corporation, Doha, Qatar
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Buechel J, Monod C, Alba Alejandre I, Ninke T, Hoesli I, Starrach T, Delius M, Mahner S, Kaltofen T. Amniotic Fluid Embolism: a comparison of two classification systems in a retrospective 8-year analysis from two tertiary hospitals. J Gynecol Obstet Hum Reprod 2023; 52:102597. [PMID: 37087046 DOI: 10.1016/j.jogoh.2023.102597] [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: 01/14/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Amniotic fluid embolism (AFE) is a rare life-threatening complication in obstetrics, but the diagnosis lacks a consensual definition. The objective of this study was to compare two different AFE classification systems by analysing the AFE cases from two university hospitals. MATERIAL AND METHODS In this retrospective study, all patients with a strong suspicion of AFE between 2014 and 2021 at two university hospitals, LMU Women's University Hospital Munich, and Women's University Hospital Basel, were included. Patient records were checked for the ICD-10 code O88.1 (AFE). Diagnoses were confirmed through clinical findings and/or autopsy. The presence of the diagnostic criteria of the Society of Maternal Fetal Medicine (SMFM) and the AFE Foundation (AFEF) and of a new framework by Ponzio-Klijanienko et al. from Paris, France, were checked and compared using Chi-square-test. RESULTS Within our study period, 38,934 women delivered in the two hospitals. Six patients had a strong suspicion of AFE (0.015%). Only three of six patients (50%) presented with all the four diagnostic criteria of the SMFM/AFEF framework. All six patients met the criteria of the modified "Paris AFE framework". CONCLUSION Using the "Paris AFE framework" based exclusively on clinical criteria can help clinicians to diagnose AFE, anticipate the life-threatening condition of the patient and prepare immediately for best clinical care.
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Affiliation(s)
- J Buechel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - C Monod
- Department of Obstetrics and Antenatal Care, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Medical Faculty, University Basel, Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - I Alba Alejandre
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - T Ninke
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - I Hoesli
- Department of Obstetrics and Antenatal Care, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Medical Faculty, University Basel, Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - T Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - T Kaltofen
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany; Department for Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Yukami S, Juri T, Nakajima A, Daisuke T, Takahashi Y, Iwata S, Yamamoto A, Mori T. Diagnosis of unicuspid aortic valve after loss of consciousness during cesarean section: A case report. Clin Case Rep 2023; 11:e7049. [PMID: 36873077 PMCID: PMC9981571 DOI: 10.1002/ccr3.7049] [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: 10/01/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Loss of consciousness is a rare but potentially serious complication of delivery by cesarean section under spinal anesthesia. Here, we report the case of a pregnant woman with unicuspid aortic valve that was incidentally diagnosed during aortic valve replacement after transient loss of consciousness during cesarean section.
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Affiliation(s)
- Shun Yukami
- Department of AnesthesiologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Takashi Juri
- Department of AnesthesiologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Asami Nakajima
- Department of Obstetrics and GynecologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Tachibana Daisuke
- Department of Obstetrics and GynecologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Yosuke Takahashi
- Department of Cardiovascular SurgeryOsaka City University Graduate School of MedicineOsakaJapan
| | - Shinichi Iwata
- Department of Cardiovascular MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional RadiologyOsaka City University Graduate School of MedicineOsakaJapan
| | - Takashi Mori
- Department of AnesthesiologyOsaka City University Graduate School of MedicineOsakaJapan
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Golzarian H, Mariam A, Shah SR, Pasley BA, Haq SH, Edgerton AR, Scherger WE, Stallkamp VL, Patel D, Laird A, Cole WC, Patel SM. Amniotic fluid embolism‐induced cardiopulmonary collapse successfully treated with combination VA‐ECMO and Impella CP. ESC Heart Fail 2022; 10:1440-1444. [PMID: 36480170 PMCID: PMC10053152 DOI: 10.1002/ehf2.14254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/30/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. Prompt and aggressive resuscitative strategies are crucial in promoting survivability. We present a case of AFE resulting in cardiopulmonary collapse and subsequent cardiac arrest where we were able to safely deliver the baby and resuscitate the mother with veno-arterial extracorporeal membrane oxygenation and Impella CP-a novel combination known as ECPELLA. We discuss the implications of this approach as a more efficacious strategy in resuscitating AFE-induced cardiogenic shock and arrest.
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Affiliation(s)
- Hafez Golzarian
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Alaha Mariam
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Sidra R. Shah
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Benjamin A. Pasley
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Syed H. Haq
- Department of Internal Medicine BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Anne R. Edgerton
- Department of General Surgery BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - William E. Scherger
- Department of Obstetrics and Gynecology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Vanessa L. Stallkamp
- Department of Obstetrics and Gynecology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Dennis Patel
- Department of Anesthesiology BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Amanda Laird
- Department of Critical Care Services BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - William C. Cole
- Department of Critical Care Services BonSecours Mercy Health—St. Rita's Medical Center Lima OH USA
| | - Sandeep M. Patel
- Structural Heart and Intervention Center BonSecours Mercy Health—St. Rita's Medical Center 730 West Market Street, 2K Tower Lima OH 45801 USA
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Lao TT. Acute respiratory distress and amniotic fluid embolism in pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 85:83-95. [PMID: 35840499 PMCID: PMC9264283 DOI: 10.1016/j.bpobgyn.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022]
Abstract
Respiratory failure in pregnant and postpartum women is uncommon, but it is one of the leading causes of maternal admission into the intensive care unit and is associated with high mortality. The underlying causes include sequelae of underlying medical conditions, such as congenital heart diseases, but it is more often related to acute respiratory distress syndrome from obstetric complications like pre-eclampsia, effect of treatment like tocolysis, coincidental to pregnancy like transfusion-related acute lung injury, and accidental like amniotic fluid embolism. The pathophysiological mechanisms involved in many of these conditions remain to be clearly established, but maternal inflammatory response and activation of the immune and complement systems appear to play leading roles. Prompt recognition of maternal respiratory distress and related manifestations and aggressive and adequate supportive treatment, especially cardiopulmonary resuscitation, ventilation, maintenance of circulation, and timely termination of the pregnancy, play key roles in achieving survival of both mother and foetus.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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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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12
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Rasheed W, Tasnim S, Dweik A, Anil MS, Anees MA. A Case of Severe Acute Respiratory Distress Syndrome Secondary to Atypical Amniotic Fluid Embolism. Cureus 2022; 14:e28808. [PMID: 36225511 PMCID: PMC9534531 DOI: 10.7759/cureus.28808] [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] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edema that leads to acute respiratory distress. It remains one of the major diagnoses requiring ICU admission and mechanical ventilation. We present a case of a 25-year-old gravida 3 para 2 female who was admitted for uncomplicated 38-week pregnancy and delivered a healthy male infant but developed acute onset dyspnea six hours after vaginal delivery. She required mechanical ventilation four hours after the onset of respiratory distress and had to be transferred to a higher level facility for extracorporeal membrane oxygenation (ECMO) within 24 hours of the symptom onset. She was diagnosed with severe ARDS. Even though she missed the other typical feature of amniotic fluid embolism, atypical amniotic fluid embolism remained the most likely explanation for her symptoms after the other causes of ARDS were excluded.
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Affiliation(s)
- Waqas Rasheed
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Saria Tasnim
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Anass Dweik
- Internal Medicine, Texas Tech University Health Sciences Center, Texas, USA
| | | | - Muhammad Ali Anees
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
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13
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Panda S, Das A, Sharma N, Das R, Jante DV. Amniotic Fluid Embolism After First-Trimester Abortion. Cureus 2022; 14:e24490. [PMID: 35651466 PMCID: PMC9135588 DOI: 10.7759/cureus.24490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/11/2022] Open
Abstract
Amniotic fluid embolism (AFE) may be a rare event in pregnancy, especially after a first-trimester medical termination of pregnancy (MTP). A 35-year-old G3P2L2 came to our outpatient department at six weeks of pregnancy for medical termination of pregnancy and bilateral tubal ligation. After around one hour of surgery, she developed respiratory distress with abdominal distension, hypotension, tachycardia and tachypnoea. On laparotomy, we found ascitic fluid, bowels with petechia, and oozing all over the wounds. Finally, within 24 hours of surgery, she expired. Strong clinical suspicion of AFE should prompt a multidisciplinary team including anaesthesia, respiratory therapy, critical care, and maternal-foetal medicine to be involved in the ongoing care of women with AFE.
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14
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Aissi James S, Klein T, Lebreton G, Nizard J, Chommeloux J, Bréchot N, Pineton de Chambrun M, Hékimian G, Luyt CE, Levy B, Kimmoun A, Combes A, Schmidt M. Amniotic fluid embolism rescued by venoarterial extracorporeal membrane oxygenation. Crit Care 2022; 26:96. [PMID: 35392980 PMCID: PMC8988404 DOI: 10.1186/s13054-022-03969-3] [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: 12/14/2021] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device.
Methods This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021. Clinical characteristics, critical care management, in-intensive care unit (ICU) complications, and hospital outcomes were collected. ICU survivors were assessed for health-related quality of life (HRQL) in May 2021. Results During that 13-year study period, VA-ECMO was initiated in 54 parturient women in two high ECMO volume centers. Among that population, 10 patients with AFE [median (range) age 33 (24–40), SAPS II at 69 (56–81)] who fulfilled our diagnosis criteria were treated with VA-ECMO. Pregnancy evolved for 36 (30–41) weeks. Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Pre-ECMO hemodynamic was severely impaired with an inotrope score at 370 (55–1530) μg/kg/min, a severe left ventricular ejection fraction measured at 14 (0–40)%, and lactate at 12 (2–30) mmol/L. 70% of these patients were alive at hospital discharge despite an extreme pre-ECMO severity and massive blood product transfusion. However, HRQL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up. Conclusion In this rare per-delivery complication, our results support the use of VA-ECMO despite intense DIC and ongoing bleeding. Future studies should focus on customized, patient-centered, rehabilitation programs that could lead to improved HRQL in this population.
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Affiliation(s)
- Sarah Aissi James
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Thomas Klein
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.,Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Jacky Nizard
- Department of Gynaecology and Obstetrics, Groupe Hospitalier Pitié-Salpêtrière, CNRS UMR 7222, INSERM U1150, Sorbonne Universités, Paris, France
| | - Juliette Chommeloux
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Nicolas Bréchot
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Guillaume Hékimian
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France
| | - Bruno Levy
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Antoine Kimmoun
- Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur Et Des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France.,Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France. .,Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, 75013, Paris, France. .,Sorbonne Université, GRC 30, RESPIRE, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France. .,Service de Medecine Intensive Reanimation, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
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15
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Barakat M, Alamami A, Ait Hssain A. Recurrent Cardiac Arrests Due to Amniotic Fluid Embolism. Cureus 2022; 14:e22475. [PMID: 35371701 PMCID: PMC8943441 DOI: 10.7759/cureus.22475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare but devastating complication of pregnancy and is associated with high morbidity and mortality. Identifiable maternal risk factors for AFE include older age, multiparity, cesarean section, and placenta previa, while fetal factors include male gender, fetal distress, and death. AFE presents with respiratory distress, seizure, and circulatory collapse and can be complicated with disseminated intravascular coagulopathy, multiorgan failure, and death. In our case, we present a patient who underwent elective cesarean section for placenta previa, which was complicated by sudden cardiac arrest immediately after delivering the placenta in the operating theatre followed by disseminated intravascular coagulation (DIC). The patient developed massive post-partum hemorrhage secondary to the underlying DIC, which required a massive blood transfusion along with platelets, fresh frozen plasma (FFP), and tranexamic acid. The Society of Maternal-Fetal Medicine proposed criteria for the diagnosis of AFE, which include clinical features and laboratory findings. The presence of a DIC picture is considered to be the hallmark finding that helps to differentiate between AFE and other conditions with similar presentation. Treatment of amniotic fluid embolism depends on early recognition and supportive care.
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16
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Barbagallo M, Schiappa E. MOF in Pregnancy and Its Relevance to Eclampsia. POSTINJURY MULTIPLE ORGAN FAILURE 2022:205-239. [DOI: 10.1007/978-3-030-92241-2_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Lim LM, Sim XJ, Sng B. Amniotic fluid embolism with cardiac arrest and coagulopathy during Cesarean section: A case report. BALI JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.4103/bjoa.bjoa_96_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Xie Y, Liang J, Mu Y, Liu Z, Wang Y, Dai L, Li X, Li Q, Li M, Chen P, Zhu J, Wang X. Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study. BMJ Open 2021; 11:e047983. [PMID: 34588243 PMCID: PMC8479942 DOI: 10.1136/bmjopen-2020-047983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aims to use the high-quality national monitoring data from the China's National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes. SETTINGS Observational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS. PARTICIPANTS 11 667 406 women were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES We screened for the incidence, trends, risk factors and main reasons for obstetric MBT, and the outcomes after obstetric MBT. MBT was defined as the transfusion of ≥5 units of red blood cells or ≥1000 mL of whole blood. The incidence of MBT was defined as the MBT cases per 10 000 pregnancies. RESULTS Obstetric MBT occurred in 27 626 cases, corresponding to an incidence of 23.68 per 10 000 maternities, which exhibited an increasing trend in China during 2012-2019 (14.03-29.59 per 10 000 maternities, p for trend <0.001). Obstetric MBT was mainly associated with amniotic fluid embolism, uterine atony, abnormal placenta, severe anaemia, ectopic pregnancy, abortion, caesarean section, advanced maternal age and multiparous from biological effect. While from sociological effects, uterine atony, severe anaemia and placenta previa are the top three complications which more likely to undergo obstetric MBT in the Chinese population. Overall, the secular trends of hysterectomy incidence (25.07%-9.92%) and MMR during hospitalisation (21.41‰-7.48‰) among women who underwent MBT showed decreasing trends (p for trend <0.001). CONCLUSION To minimise the incidence of obstetric MBT, more attention should be paid to education on the importance of the antenatal visit, evidence-based transfusion practice and females who are multiparous and have an advanced age, amniotic fluid embolism, uterine atony, severe anaemia and placenta previa.
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Affiliation(s)
- Yanxia Xie
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
- Department of Obstetrics, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Li Dai
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
- Medical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Peiran Chen
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaodong Wang
- Department of Obstetrics, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
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19
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Kidson KM, Lapinsky S, Grewal J. A Detailed Review of Critical Care Considerations for the Pregnant Cardiac Patient. Can J Cardiol 2021; 37:1979-2000. [PMID: 34534620 DOI: 10.1016/j.cjca.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023] Open
Abstract
Maternal cardiovascular disease is a leading cause of maternal death worldwide and recently, maternal mortality has increased secondary to cardiovascular causes. Maternal admissions to critical care encompass 1%-2% of all critical care admissions, and although not common, the management of the critically ill pregnant patient is complex. Caring for the critically ill pregnant cardiac patient requires integration of pregnancy-associated physiologic changes, understanding pathophysiologic disease states unique to pregnancy, and a multidisciplinary approach to timing around delivery as well as antenatal and postpartum care. Herein we describe cardiorespiratory changes that occur during pregnancy and the differential diagnosis for cardiorespiratory failure in pregnancy. Cardiorespiratory diseases that are either associated or exacerbated by pregnancy are highlighted with emphasis on perturbations secondary to pregnancy and appropriate management strategies. Finally, we describe general management of the pregnant cardiac patient admitted to critical care.
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Affiliation(s)
- Kristen M Kidson
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Stephen Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Grewal
- Division of Cardiology, University of British Columbia, Pacific Adult Congenital Heart Disease Program, St Paul's Hospital, Vancouver, British Columbia, Canada.
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20
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Chiao SS, Sheeran JS. Extracorporeal Membrane Oxygenation Therapy After Amniotic Fluid Embolism With Undetectable ROTEM FIBTEM Activity: A Case Report. A A Pract 2021; 14:e01349. [PMID: 33185411 DOI: 10.1213/xaa.0000000000001349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Amniotic fluid embolism (AFE) is a rare but devastating condition with mortality rates as high as 60%-80%., We report a case of AFE complicating the labor of a parturient with no reported risk factors. She received general anesthesia for emergent cesarean delivery (CD), after which she developed a pulseless electrical activity (PEA) event requiring resuscitation, disseminated intravascular coagulation, and postpartum hemorrhage with undetectable fibrinogen activity by ROTEM FIBTEM assay. Extracorporeal membrane oxygenation (ECMO) therapy was successfully initiated, and she was discharged home without neurologic sequelae. ECMO therapy can be considered for the treatment of AFE even in the absence of fibrinogen activity.
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Affiliation(s)
- Sunny S Chiao
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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21
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Fibrinogen may aid in the early differentiation between amniotic fluid embolism and postpartum haemorrhage: a retrospective chart review. Sci Rep 2021; 11:8379. [PMID: 33863968 PMCID: PMC8052446 DOI: 10.1038/s41598-021-87685-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/31/2021] [Indexed: 12/13/2022] Open
Abstract
This study aimed to determine whether blood loss and fibrinogen can differentiate amniotic fluid embolism (AFE) from postpartum haemorrhage (PPH). This retrospective case–control study included nine patients with clinical AFE (“AFE group”) and 78 patients with PPH managed at our tertiary care perinatal centre between January 2014 and March 2016. Patients meeting the Japanese diagnostic criteria for AFE were stratified into cardiopulmonary collapse-type AFE and disseminated intravascular coagulation (DIC)-type AFE groups. The relationship between blood loss and fibrinogen at onset was examined to compare DIC severity. Vital signs at onset were not significantly different. The AFE group had significantly less blood loss at onset (1506 mL vs 1843 mL, P = 0.0163), significantly more blood loss 2 h post-onset (3304 mL vs 1996 mL, P < 0.0001) and more severe coagulopathy and fibrinolysis. The blood loss/fibrinogen (B/F) ratio at onset was significantly higher in the DIC-type AFE group (23.15 ± 8.07 vs 6.28 ± 3.35 mL dL/mg, P < 0.0001). AFE was complicated by catastrophic DIC irrespective of blood loss at onset. Fibrinogen exhibited the strongest correlation among test findings at onset. The B/F ratio may help differentiate PPH from DIC-type AFE and diagnose clinical AFE, facilitating optimal replacement of coagulation factors during the early stages.
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22
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Durgam S, Sharma M, Dadhwal R, Vakil A, Surani S. The Role of Extra Corporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Case Report and Literature Review. Cureus 2021; 13:e13566. [PMID: 33791181 PMCID: PMC8005271 DOI: 10.7759/cureus.13566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare and life-threatening complication related to pregnancy. Early diagnosis and prompt intervention are important tools for the survival of the patient. Despite early intervention, mortality rate remains high. We present a case of a 19-year-old female who was admitted for labor induction and delivery. Her delivery course was complicated by meconium-stained amniotic fluid. The patient went into acute hypoxic respiratory failure (AHRF) and hemodynamic compromise within half an hour following delivery secondary to AFE. We hereby discuss the role of timely initiation of extra corporeal membrane oxygenation (ECMO) in a case of AFE which could have otherwise turned out to be fatal.
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Affiliation(s)
- Shalini Durgam
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Munish Sharma
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Rahul Dadhwal
- Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Abhay Vakil
- Internal Medicine, University of North Texas, Denton, USA
| | - Salim Surani
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.,Internal Medicine, University of North Texas, Dallas, USA
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23
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Bouvet L, Gariel C, Charvet A, Boisson-Gaudin C, Chassard D. Contribution of blood detection of insulin-like growth factor binding protein-1 for the diagnosis of amniotic-fluid embolism: a retrospective multicentre cohort study. BJOG 2021; 128:1966-1973. [PMID: 33595867 DOI: 10.1111/1471-0528.16672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the contribution of maternal blood detection of IGFBP-1 for the diagnosis of amniotic-fluid embolism in clinical daily practice. DESIGN A retrospective multicentre cohort study. SETTING Three tertiary care obstetric units in France. SAMPLE Data of 86 women for whom amniotic-fluid embolism had been suspected and maternal serum detection of IGFBP-1 had been performed between 2011 and 2019 were analysed. METHODS The criteria defined by the United Kingdom Obstetric Surveillance System (UKOSS) were used for the retrospective diagnosis of amniotic-fluid embolism. The more structured definition proposed by the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation (SMFM) was also used as secondary endpoint. MAIN OUTCOME MEASURES Agreements between biological and clinical assessments were tested. The performance of blood detection of IGFBP-1 for the diagnosis of amniotic-fluid embolism according to the UKOSS criteria, and to the SMFM definition, was also assessed. RESULTS There was only slight agreement between clinical and laboratory diagnosis of amniotic-fluid embolism (Cohen's Kappa coefficient: 0.04). Blood detection of IGFBP-1 had a sensitivity of 16%, a specificity of 88%, a positive and a negative likelihood ratio of 1.3 and 0.95, respectively, and a positive and a negative predictive value of 58 and 50%, respectively, for the diagnosis of amniotic-fluid embolism based on the UKOSS criteria. The use of the more structured SMFM definition of amniotic-fluid embolism did not substantially change the results. CONCLUSION These results question the usefulness of blood detection of IGFBP-1 for the early diagnosis of amniotic-fluid embolism in daily clinical practice. TWEETABLE ABSTRACT This retrospective multicentre study questions the contribution of IGFBP-1 detection for the diagnosis of AFE.
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Affiliation(s)
- L Bouvet
- Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,University of Lyon, Claude Bernard Lyon 1 University, Villeurbanne, France.,APCSe VetAgro Sup UPSP 2016.A101, Marcy l'Etoile, France
| | - C Gariel
- Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France
| | - A Charvet
- Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France
| | - C Boisson-Gaudin
- Laboratory of Fetal-Maternal Biology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - D Chassard
- Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.,University of Lyon, Claude Bernard Lyon 1 University, Villeurbanne, France.,APCSe VetAgro Sup UPSP 2016.A101, Marcy l'Etoile, France
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Abstract
Over the past 30 years, maternal mortality has increased in the United States to 18 deaths per 100,000 live births. Obstetric emergencies, including hemorrhage, hypertensive disorders in pregnancy, HELLP syndrome, and amniotic fluid embolism, and anesthesia complications, including high neuraxial blockade, local anesthetic systemic toxicity, and the difficult obstetric airway, contribute to maternal cardiac arrest and maternal and fetal morbidity and mortality. Expeditious intervention by the obstetric anesthesiologist is critical in these emergent scenarios, and knowledge of best practices is essential to improve maternal and fetal outcomes.
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Affiliation(s)
- Kristen L Fardelmann
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520-8051, USA.
| | - Aymen Awad Alian
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520-8051, USA
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Abstract
Over the past 30 years, maternal mortality has increased in the United States to 18 deaths per 100,000 live births. Obstetric emergencies, including hemorrhage, hypertensive disorders in pregnancy, HELLP syndrome, and amniotic fluid embolism, and anesthesia complications, including high neuraxial blockade, local anesthetic systemic toxicity, and the difficult obstetric airway, contribute to maternal cardiac arrest and maternal and fetal morbidity and mortality. Expeditious intervention by the obstetric anesthesiologist is critical in these emergent scenarios, and knowledge of best practices is essential to improve maternal and fetal outcomes.
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Affiliation(s)
- Kristen L Fardelmann
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520-8051, USA.
| | - Aymen Awad Alian
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT 06520-8051, USA
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Evaluation of the 4 diagnosis criteria proposed by the SMFM and the AFE foundation for amniotic fluid embolism in a monocentric population. J Gynecol Obstet Hum Reprod 2020; 49:101821. [DOI: 10.1016/j.jogoh.2020.101821] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/07/2020] [Accepted: 05/22/2020] [Indexed: 11/22/2022]
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Tay JH, Goy RWL, Sng BL. Amniotic fluid embolism and management of coagulopathy: A case report with successful outcome. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820929723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare and potentially catastrophic condition unique to pregnancy. Presentation may range from subtle clinical events to sudden and fatal maternal cardiorespiratory arrest, with a reported incidence of 2–6 in 100,000 deliveries and mortality of 15–60%. Management should include immediate high-grade resuscitation for AFE presenting as cardiac arrest, involvement of multidisciplinary team, provision of adequate ventilator and circulatory support, treatment of coagulopathy precipitated by AFE, and immediate delivery of the foetus in cases of cardiac arrest. The following case report involves a patient with suspected AFE post-induction of labour with favourable maternal and neonatal outcome in our local setting. The management of coagulopathy in AFE is further discussed, including use of massive transfusion protocols, pharmacological agents and recombinant factor VIIa.
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Affiliation(s)
- Jun Hoe Tay
- Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore
| | - Raymond Wee Lip Goy
- Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore
| | - Ban Leong Sng
- Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore
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Incidence and risk factors of transfusion reactions in postpartum blood transfusions. Blood Adv 2020; 3:2298-2306. [PMID: 31366586 DOI: 10.1182/bloodadvances.2019000074] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/06/2019] [Indexed: 11/20/2022] Open
Abstract
Postpartum hemorrhages with blood transfusions are increasing in many high-resource countries. Currently, up to 3% of all women receive blood transfusion postpartum. Most blood transfusions are safe and, in many cases, are lifesaving, but there are significant concerns about adverse reactions. Pregnancy is associated with higher levels of leukocyte antibodies and has a modulating effect on the immune system. Our objective was to investigate whether blood transfusions postpartum are accompanied by an increased risk for transfusion reactions (TRs) compared with transfusions given to nonpregnant women. We included all women who gave birth in Stockholm County, Sweden between 1990 and 2011. Data from the Swedish National Birth Registry were linked to the Stockholm Transfusion Database and included information on blood components administered and whether a TR occurred in women who received blood transfusions postpartum. Background controls were nonpregnant women who received blood transfusions during the study period. The study cohort consisted of 517 854 women. Of these, 12 183 (2.4%) received a blood transfusion. We identified 96 events involving a TR postpartum, giving a prevalence of 79 per 10 000 compared with 40 per 10 000 among nonpregnant women (odds ratio, 2.0; 95% confidence interval, 1.6-2.5). Preeclampsia was the single most important risk factor for TRs (odds ratio, 2.1; 95% confidence interval, 1.7-2.6). We conclude that special care should be taken when women with preeclampsia are considered for blood transfusion postpartum, because our findings indicate that pregnancy is associated with an increased risk for TRs.
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Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism-Induced Cardiac Arrest in the First Trimester of Pregnancy: A Case Report. Crit Care Explor 2020; 2:e0162. [PMID: 32766559 PMCID: PMC7368879 DOI: 10.1097/cce.0000000000000162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Amniotic fluid embolism is a rare obstetric emergency that can be accompanied by profound hypoxemia, coagulopathy, hemorrhage, and cardiogenic shock. Extracorporeal membrane oxygenation may provide a rescue strategy in amniotic fluid embolism with cardiopulmonary collapse. Approaches to anticoagulation must be balanced against the risk of hemorrhage with concomitant coagulopathy. Although extracorporeal membrane oxygenation has been described for cardiopulmonary collapse in the setting of amniotic fluid embolism, its initiation as a bridge to hemostasis and cardiopulmonary recovery in amniotic fluid embolism–induced hemorrhagic and cardiogenic shock remains a novel resuscitation strategy.
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Naoum EE, Chalupka A, Haft J, MacEachern M, Vandeven CJM, Easter SR, Maile M, Bateman BT, Bauer ME. Extracorporeal Life Support in Pregnancy: A Systematic Review. J Am Heart Assoc 2020; 9:e016072. [PMID: 32578471 PMCID: PMC7670512 DOI: 10.1161/jaha.119.016072] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum ECLS. Methods and Results This review was registered in PROSPERO (CRD42018108142). MEDLINE, Embase, and CINAHL were searched for case reports, case series, and studies reporting cases of ECLS during the peripartum period that reported one or more of the following outcomes: maternal survival, maternal complications, fetal survival, and/or fetal complications. Qualitative assessment of 221 publications evaluated the number of cases, clinical details, and maternal and fetal outcomes of ECLS during the peripartum period. There were 358 women included and 68 reported fetal outcomes in cases where the mother was pregnant at the time of cannulation. The aggregate maternal survival at 30 days was 270 (75.4%) and at 1 year was 266 (74.3%); fetal survival was 44 (64.7%). The most common indications for ECLS overall in pregnancy included acute respiratory distress syndrome 177 (49.4%), cardiac failure 67 (18.7%), and cardiac arrest 57 (15.9%). The most common maternal complications included mild to moderate bleeding 66 (18.4%), severe bleeding requiring surgical intervention 48 (13.4%), and intracranial neurologic morbidity 19 (5.3%). The most commonly reported fetal complications included preterm delivery 33 (48.5%) and neonatal intensive care unit admission 19 (27.9%). Conclusions Reported rates of survival in ECLS in pregnant and postpartum women are high and major complications relatively low.
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Affiliation(s)
- Emily E. Naoum
- Department of AnesthesiologyUniversity of MichiganAnn ArborMI
| | - Andrew Chalupka
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General HospitalBostonMA
| | - Jonathan Haft
- Department of Cardiac SurgeryUniversity of MichiganAnn ArborMI
| | - Mark MacEachern
- Taubman Health Sciences LibraryUniversity of MichiganAnn ArborMI
| | - Cosmas J. M. Vandeven
- Department of Obstetrics and GynecologyMaternal‐Fetal MedicineUniversity of MichiganAnn ArborMI
| | - Sarah Rae Easter
- Division of Maternal‐Fetal MedicineDepartment of Obstetrics and GynecologyBrigham and Women’s HospitalBostonMA
| | - Michael Maile
- Department of AnesthesiologyUniversity of MichiganAnn ArborMI
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of MedicineDepartment of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalBostonMA
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Kinishi Y, Ootaki C, Iritakenishi T, Fujino Y. A case of amniotic fluid embolism successfully treated by multidisciplinary treatment. JA Clin Rep 2019; 5:79. [PMID: 32026080 PMCID: PMC6967009 DOI: 10.1186/s40981-019-0296-0] [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: 07/16/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022] Open
Abstract
Background Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency. Because the maternal mortality associated with AFE is very high, early recognition and prompt treatment are important for improving the prognosis. We report a case of amniotic fluid embolism successfully treated by multidisciplinary treatment. Case presentation A 39-year-old woman with fetal congenital heart anomaly and polyhydramnios was scheduled for induction of delivery at 37 weeks of gestation with labor epidural analgesia. Uncontrollable bleeding occurred 30 min after vaginal delivery. Based on the clinical diagnosis of AFE, massive blood transfusion, insertion of an aortic occlusion balloon catheter, and hysterectomy was performed. Total blood loss was 12,000 mL. The diagnosis of AFE was confirmed by pathological examination. She was discharged with no complications. Conclusion We report a case of AFE who were rescued by prompt diagnosis and treatment.
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Affiliation(s)
- Yuki Kinishi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Chiyo Ootaki
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takeshi Iritakenishi
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Johnson AL, Reader JR. Pulmonary amniotic fluid embolism in a rhesus macaque (Macaca mulatta). J Med Primatol 2019; 49:60-62. [PMID: 31742695 DOI: 10.1111/jmp.12450] [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: 08/23/2019] [Revised: 10/16/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
A pregnant female rhesus macaque died spontaneously during stage two labor. Gross and histopathologic findings included severe pulmonary edema, with low numbers of blood vessels containing pale basophilic mucinous material (Alcian Blue positive and PTAH negative), consistent with intravascular amniotic fluid-derived mucin resulting in pulmonary amniotic fluid embolism.
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Affiliation(s)
- Amanda L Johnson
- California National Primate Research Center, Anatomic and Clinical Pathology Service, University of California, Davis, California
| | - J Rachel Reader
- California National Primate Research Center, Anatomic and Clinical Pathology Service, University of California, Davis, California
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Abstract
In a Perspective, Sarka Lisonkova and Michael Kramer discuss the accompanying study by Kathryn Fitzpatrick and co-authors on management of amniotic fluid embolism.
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Affiliation(s)
- Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael S. Kramer
- Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, Deneux-Tharaux C, Kristufkova A, Li Z, Schaap TP, Sullivan EA, Tuffnell D, Knight M. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Med 2019; 16:e1002962. [PMID: 31714909 PMCID: PMC6850527 DOI: 10.1371/journal.pmed.1002962] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Amniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions. METHODS AND FINDINGS A population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99-218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank-sum test. The estimated incidence of AFE ranged from 0.8-1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%-41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors associated with poor maternal outcomes amongst women with AFE. Using the most liberal case definition (UK) and adjusting for the severity of presentation when appropriate, women who died were more likely than those who survived to present with cardiac arrest (89% versus 40%, adjusted odds ratio [aOR] 10.58, 95% confidence interval [CI] 3.93-28.48, p < 0.001) and less likely to have a source of concentrated fibrinogen (40% versus 56%, aOR 0.44, 95% CI 0.21-0.92, p = 0.029) or platelets given (24% versus 49%, aOR 0.23, 95% CI 0.10-0.52, p < 0.001). They also had a lower dose of tranexamic acid (median dose 0.7 g versus 2 g, p = 0.035) and were less likely to have had an obstetrician and/or anaesthetist present at the time of the AFE (61% versus 75%, aOR 0.38, 95% CI 0.16-0.90, p = 0.027). Limitations of the study include limited statistical power to examine factors associated with poor maternal outcome and the potential for residual confounding or confounding by indication. CONCLUSIONS The findings of our study suggest that when an AFE is suspected, initial supportive obstetric care is important, but having an obstetrician and/or anaesthetist present at the time of the AFE event and use of interventions to correct coagulopathy, including the administration of an adequate dose of tranexamic acid, may be important to improve maternal outcome. Future research should focus on early detection of the coagulation deficiencies seen in AFE alongside the role of tranexamic acid and other coagulopathy management strategies.
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Affiliation(s)
- Kathryn E. Fitzpatrick
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kitty W. M. Bloemenkamp
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catherine Deneux-Tharaux
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, Paris, France
| | - Alexandra Kristufkova
- First Department of Obstetrics and Gynaecology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zhuoyang Li
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Timme P. Schaap
- Birth Centre Wilhelmina Children Hospital, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elizabeth A. Sullivan
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Derek Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Chen W, Qi J, Shang Y, Ren L, Guo Y. Amniotic fluid embolism and spontaneous hepatic rupture during uncomplicated pregnancy: a case report and literature review. J Matern Fetal Neonatal Med 2018; 33:1759-1766. [PMID: 30394159 DOI: 10.1080/14767058.2018.1526915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Amniotic fluid embolism (AFE) and spontaneous hepatic rupture both are extremely rare complications of pregnancy that can be fatal to mother and/or child. AFE is characterized by a sudden collapse of the cardiovascular system, a change in mental status, and disseminated intravascular coagulation (DIC), occurring immediately during labor, delivery, or postpartum, caused by the inflow of amniotic components into the maternal circulation. Spontaneous hepatic rupture during pregnancy which is most often occurs alongside hypertensive disorders, eclampsia, or HELLP syndrome. We report on the case of a 28-year-old woman (G3P2) who is suffering from AFE and spontaneous hepatic rupture, without history of hypertensive disorders, preeclampsia/eclampsia, or HELLP syndrome, and she died suddenly after delivering of a severe asphyxial neonate within 1 h with postpartum of hepatic rupture and massive hemorrhage. The lack of typical clinical signs and symptoms resulted to the difficulty of early diagnosis. If AFE and hepatic rupture is highly suspected in a pregnant patient, a collaborative multidisciplinary approach is mandatory. Pregnancy women is simultaneously complicated in amniotic fluid embolism and spontaneous hepatic rupture, similar cases are infrequent in the literature, which is reviewed in this report, explore the pathophysiological changes, we hope that can be helpful for the prevention, diagnosis and treatment of similar cases.
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Affiliation(s)
- Wei Chen
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Jialin Qi
- Department of Pathology, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Yanjie Shang
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Lipin Ren
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Yadong Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
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Oglesby F, Marsh C. Amniotic fluid embolism: a diagnosis of exclusion in cases of maternal collapse. Br J Hosp Med (Lond) 2018; 79:C157-C160. [PMID: 30290750 DOI: 10.12968/hmed.2018.79.10.c157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fiona Oglesby
- Clinical Fellow in Anaesthesia, Department of Anaesthesia, Royal United Hospitals, Bath BA1 3NG
| | - Chris Marsh
- Consultant in Anaesthesia and Obstetric Lead, Department of Anaesthesia, Royal United Hospitals, Bath
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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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Skolnik S, Ioscovich A, Eidelman LA, Davis A, Shmueli A, Aviram A, Orbach-Zinger S. Anesthetic management of amniotic fluid embolism -- a multi-center, retrospective, cohort study. J Matern Fetal Neonatal Med 2017; 32:1262-1266. [PMID: 29166810 DOI: 10.1080/14767058.2017.1404024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Amniotic fluid embolism (AFE) is a rare and potentially lethal obstetric complication, commonly occurring during labor, delivery, or immediately postpartum. There is a paucity of data regarding incidence, risk factors, and clinical management. Our primary objective in this study was to evaluate clinical presentation of AFE and delineate anesthesia management of these cases. METHODS This 10 years retrospective multi-center cohort study was performed in five tertiary university-affiliated medical centers, between the years 2005 and 2015. All documented cases of AFE identified according to the ICD guidelines were reviewed manually to determine eligibility for AFE according to Clark's criteria. All cases confirming Clark's diagnosis were included in the cohort. RESULTS Throughout the study period, 20 cases of AFE were identified, with an incidence of 4.1 per 100,000 births. Average age at presentation was 35 ± 5 years. Seventy percent of cases presented during vaginal delivery, 20% occurred throughout a cesarean delivery, and 10% occurred during a dilation and evacuation procedure. The most common presenting symptom was sudden loss of consciousness in 12 parturients (66.7%), fetal bradycardia in 11 parturients (55%), and shortness of breath in 10 parturients (50%). Perimortem cesarean section was performed in 55% of cases, although only one case was performed in the delivery suite, while all others were performed in the operating room. Echocardiography was performed in 60% of the cases and all were pathological. Furthermore, 20% of cases were connected to an extracorporeal membrane oxygenation machine. There was a 15% mortality rate of 15%. A further 15% suffered major neurological disability, 25% suffered minor neurological morbidity, and 45% survived without severe complications. CONCLUSION AFE is associated with significant maternal morbidity. This study highlights the importance of providing advanced training for the delivery suite staff for cases of maternal cardiovascular collapse secondary to AFE and increasing awareness for this rare and devastating obstetric condition.
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Affiliation(s)
- Shiri Skolnik
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Alexander Ioscovich
- b Department of Anesthesia , Shaare Zedek Medical Center, Hebrew University of Jerusalem , Jerusalem , Israel
| | - Leonid A Eidelman
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Atara Davis
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Anat Shmueli
- c Department of Obstetrics and Gynecology, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
| | - Amir Aviram
- d Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center , Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sharon Orbach-Zinger
- a Department of Anesthesia, and Sackler Faculty of Medicine , Rabin Medical Center, Beilinson Hospital, Petach Tikvah Israel, Tel Aviv University , Tel Aviv , Israel
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Benson MD. Amniotic fluid embolism mortality rate. J Obstet Gynaecol Res 2017; 43:1714-1718. [PMID: 28817205 DOI: 10.1111/jog.13445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/29/2017] [Accepted: 06/10/2017] [Indexed: 11/27/2022]
Abstract
AIM The objective of this study was to determine the mortality rate of amniotic fluid embolism (AFE) using population-based studies and case series. METHODS A literature search was conducted using the two key words: 'amniotic fluid embolism (AFE)' AND 'mortality rate'. Thirteen population-based studies were evaluated, as well as 36 case series including at least two patients. RESULTS The mortality rate from population-based studies varied from 11% to 44%. When nine population-based studies with over 17 000 000 live births were aggregated, the maternal mortality rate was 20.4%. In contrast, the mortality rate of AFE in case series varies from 0% to 100% with numerous rates in between. CONCLUSION The AFE mortality rate in population-based studies varied from 11% to 44% with the best available evidence supporting an overall mortality rate of 20.4%. Data from case series should no longer be used as a basis for describing the lethality of AFE.
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Affiliation(s)
- Michael D Benson
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Caeiro AFC, Ramilo IDTM, Santos AP, Ferreira E, Batalha IS. Amniotic Fluid Embolism. Is a New Pregnancy Possible? Case Report. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2017; 39:369-372. [PMID: 28464190 PMCID: PMC10416167 DOI: 10.1055/s-0037-1601428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022] Open
Abstract
Amniotic fluid embolism (AFE) is a rare but potentially catastrophic clinical condition, characterized by a combination of signs and symptoms that reflect respiratory distress, cardiovascular collapse and disseminated intravascular coagulation (DIC). Its pathogenesis is still unclear. More recently, the traditional view of obstruction of pulmonary capillary vessels by amniotic fluid emboli as the main explanation for the etiology has been ruled out, and immunologic factors and the activation of the inflammatory cascade took on an important role. Amniotic fluid embolism has an unpredictable character, its diagnosis is exclusively clinical, and the treatment consists mainly of cardiovascular support and administration of blood products to correct the DIC. No diagnostic test is recommended until now, though multiple blood markers are currently being studied. The authors present a case report of a woman who had survived AFE in her previous pregnancy and had a subsequent pregnancy without recurrence, providing one more clinical testimony of the low risks for the pregnancy after AFE.
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Affiliation(s)
| | | | - Ana Paula Santos
- Department of Gynecology and Obstetrics, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Elizabeth Ferreira
- Department of Gynecology and Obstetrics, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Isabel Santos Batalha
- Department of Gynecology and Obstetrics, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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Tobin C, H. Wilson S, A. Rodriguez P, B. Lazenby G, R. Dempsey A. Amniotic Fluid Embolism during Dilation and Evacuation during 2nd Trimester Treated by ACLS Guidelines, ECMO and Dialysis: A Case Report. ACTA ACUST UNITED AC 2017. [DOI: 10.15436/2377-1364.17.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature. AJR Am J Roentgenol 2017; 208:505-516. [DOI: 10.2214/ajr.16.17326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Indraccolo U, Battistoni C, Mastrantonio I, Di Iorio R, Greco P, Indraccolo SR. Risk factors for fatality in amniotic fluid embolism: a systematic review and analysis of a data pool. J Matern Fetal Neonatal Med 2017; 31:661-665. [PMID: 28282766 DOI: 10.1080/14767058.2017.1293034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Investigating risk factors for amniotic fluid embolism (AFE)-induced fatality. METHODS A systematic review of cases of AFE available on PubMed, Scielo, Scopus and AJOL databases that occurred from 1990 to 2015 was carried out. After careful reading of titles, abstracts and full texts, case reports of AFE were reviewed. Risk factors for AFE were considered as independent variables in logistic regression models. The first model was built on the whole data pool. The second model was built on typical cases of AFE, according to the classical triad of symptoms (heart, lungs, coagulopathy). The dependent variable was fatality in both models. RESULTS 177 cases of AFE were assessed in the first model, while 121 typical cases of AFE were assessed in the second model. Among typical cases of AFE, only oxytocin infusion during labour increases the likelihood of death (odds ratio 2.890, 95% confidence interval 1.166-7.164, p = 0.022). No risk factors for fatality were found in the whole data pool. CONCLUSIONS Further research on national registries should focus on the behaviour of oxytocin infusion during labour in AFE cases.
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Affiliation(s)
- Ugo Indraccolo
- a Complex Operative Unit of Obstetrics and Gynecology , "Alto Tevere" Hospital of Città di Castello, ASL 1 Umbria , Città di Castello , Italy
| | - Caterina Battistoni
- b Department of Gynecological, Obstetrical, and Urological Sciences , "Sapienza" University of Rome , Rome , Italy
| | - Irene Mastrantonio
- b Department of Gynecological, Obstetrical, and Urological Sciences , "Sapienza" University of Rome , Rome , Italy
| | - Romolo Di Iorio
- c Department of Surgical and Clinical Sciences and Translational Medicine , "Sapienza" University of Rome , Rome , Italy
| | - Pantaleo Greco
- d Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
| | - Salvatore Renato Indraccolo
- b Department of Gynecological, Obstetrical, and Urological Sciences , "Sapienza" University of Rome , Rome , Italy
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Mita K, Tsugita K, Yasuda Y, Matsuki Y, Obata Y, Matsuki Y, Kamisawa S, Shigemi K. A successfully treated case of cardiac arrest after Caesarean section complicated by pheochromocytoma crisis and amniotic fluid embolism. J Anesth 2016; 31:140-143. [PMID: 27832332 DOI: 10.1007/s00540-016-2281-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/02/2016] [Indexed: 11/26/2022]
Abstract
Both pheochromocytoma and amniotic fluid embolism (AFE) are important causes of maternal mortality. We present a case of a 29-year-old woman who developed cardiac arrest after Caesarean section, complicated by both pheochromocytoma crisis and AFE. After resuscitation, the patient developed multiple organ dysfunction, rhabdomyolysis and disseminated intravascular coagulation (DIC). After institution of multidisciplinary interventions (including the use of an intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous hemodiafiltration, and neuroprotective therapeutic hypothermia) the patient made a full recovery without any apparent neurological deficit.
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Affiliation(s)
- Kenichiro Mita
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
| | - Kayo Tsugita
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Yoshikazu Yasuda
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan.
| | - Yasunari Matsuki
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
| | - Yurie Obata
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
| | - Yuka Matsuki
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Seiichi Kamisawa
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
| | - Kenji Shigemi
- Department of Intensive Care Unit, University of Fukui Hospital, 23-3 Matsuoka Shimoaizuki, Eiheijicho, Yoshidagun, Fukui, 910-1193, Japan
- Department of Anesthesiology and Reanimatology, University of Fukui Hospital, Fukui, Japan
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Mu Y, McDonnell N, Li Z, Liang J, Wang Y, Zhu J, Sullivan E. Amniotic fluid embolism as a cause of maternal mortality in China between 1996 and 2013: a population-based retrospective study. BMC Pregnancy Childbirth 2016; 16:316. [PMID: 27760522 PMCID: PMC5069862 DOI: 10.1186/s12884-016-1106-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyse the maternal mortality ratio, demographic and pregnancy related details in women who suffered a fatal amniotic fluid embolism (AFE) in China. METHODS A retrospective population based study using data collected as part of the National Maternal Mortality Surveillance System between 1996 and 2013. Data were collected onto a standardised form from women whose cause of death was listed as being secondary to AFE. RESULTS Records were available for 640 deaths. Over the 17 year period the maternal mortality ratio for AFE decreased from 4.4 per 100,000 births (95 % confidence interval (CI):2.72-6.12) to 1.9 per 100,000 births (95 % CI:1.35-2.54). Over the same period the proportion of maternal deaths secondary to AFE increased from 6.8 to 12.5 %. The mean age of women who died was 30.1 years and the onset of the AFE occurred prior to delivery in 39 %. The most prominent presenting features included premonitory symptoms (29 %), acute fetal compromise (28 %), maternal haemorrhage (16 %) and shortness of breath (15 %). CONCLUSIONS Maternal mortality secondary to AFE has decreased in China, however at a slower rate than mortality secondary to other conditions. Active surveillance is recommended to assess case fatality rates, risk factors and other lessons specific to this population.
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Affiliation(s)
- Yi Mu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Nolan McDonnell
- School of Women's and Infants' Health and School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.,Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, WA, 6008, Australia
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China.
| | - Elizabeth Sullivan
- Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, Sydney, NSW, 2007, Australia.
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Hasegawa A, Murakoshi T, Otsuki Y, Torii Y. Clinical course of disseminated intravascular coagulopathy-type amniotic fluid embolism: A report of three cases. J Obstet Gynaecol Res 2016; 42:1881-1885. [PMID: 27650060 DOI: 10.1111/jog.13142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/26/2016] [Accepted: 07/17/2016] [Indexed: 11/26/2022]
Abstract
Amniotic fluid embolism (AFE) is a rare complication of pregnancy and its mortality rate is high. There have been few reports of AFE with presence of severe coagulopathy and incoagulable bleeding, and absence of cardiopulmonary symptoms or limited cardiopulmonary symptoms, followed by massive blood loss during delivery. Such cases have been referred to as disseminated intravascular coagulopathy-type AFE, and the characteristics of this condition have been presented previously. Here we report three cases that fulfilled the diagnostic characteristics of disseminated intravascular coagulopathy-type AFE.
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Affiliation(s)
- Akihiro Hasegawa
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Shizuoka, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Shizuoka, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yuichi Torii
- Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Shizuoka, Japan
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Pacheco LD, Saade G, Hankins GDV, Clark SL. Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol 2016; 215:B16-24. [PMID: 26987420 DOI: 10.1016/j.ajog.2016.03.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/22/2016] [Accepted: 03/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism. STUDY DESIGN A systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. The search was restricted to English-language articles published from 1966 through March 2015. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used for defining the strength of recommendations and rating quality of the evidence. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. RESULTS AND RECOMMENDATIONS We recommend the following: (1) we recommend consideration of amniotic fluid embolism in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman (GRADE 1C); (2) we do not recommend the use of any specific diagnostic laboratory test to either confirm or refute the diagnosis of amniotic fluid embolism; at the present time, amniotic fluid embolism remains a clinical diagnosis (GRADE 1C); (3) we recommend the provision of immediate high-quality cardiopulmonary resuscitation with standard basic cardiac life support and advanced cardiac life support protocols in patients who develop cardiac arrest associated with amniotic fluid embolism (GRADE 1C); (4) we recommend that a multidisciplinary team including anesthesia, respiratory therapy, critical care, and maternal-fetal medicine should be involved in the ongoing care of women with AFE (Best Practice); (5) following cardiac arrest with amniotic fluid embolism, we recommend immediate delivery in the presence of a fetus ≥23 weeks of gestation (GRADE 2C); (6) we recommend the provision of adequate oxygenation and ventilation and, when indicated by hemodynamic status, the use of vasopressors and inotropic agents in the initial management of amniotic fluid embolism. Excessive fluid administration should be avoided (GRADE 1C); and (7) because coagulopathy may follow cardiovascular collapse with amniotic fluid embolism, we recommend the early assessment of clotting status and early aggressive management of clinical bleeding with standard massive transfusion protocols (GRADE 1C).
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Affiliation(s)
- Luis D Pacheco
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - George Saade
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Gary D V Hankins
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Steven L Clark
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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