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Tschöp J, Lier H, Annecke T. Anästhesiologisches Management der Fruchtwasserembolie. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:674-685. [PMID: 33242901 DOI: 10.1055/a-1070-6843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Oh SY, Roh CR. Contemporary medical understanding of the 'no-fault accident' during birth: amniotic fluid embolism, pulmonary embolism, meconium aspiration syndrome, and cerebral palsy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.9.784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheong-Rae Roh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Matsuda Y, Kamitomo M. Amniotic Fluid Embolism: A Comparison between Patients Who Survived and Those Who Died. J Int Med Res 2009; 37:1515-21. [DOI: 10.1177/147323000903700529] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate comparative clinical courses for a series of women with amniotic fluid embolism (AFE) and to assess factors associated with patient survival. Clinical courses of nine patients with AFE in a single tertiary centre were reviewed. AFE was diagnosed when a woman presented with typical clinical symptoms accompanied by abnormal laboratory tests (including abnormal coagulation) or at autopsy when fetal debris was found in the maternal pulmonary arteries. Five patients survived and four died. The first clinical manifestations of AFE were variable; dyspnoea was noted in only four patients. Other signs were state of shock, abdominal pain and uterine atony. The mean ± SD interval between the onset of clinical manifestations and treatment was significantly shorter for survivors (48.0 ± 36.3 min) than for non-survivors (137.5 ± 49.7 min). The number of failed organs was significantly fewer for the survivors compared with the non-survivors. AFE was accompanied by a wide variety of clinical manifestations, but early diagnosis and treatment appeared to be the most critical factors associated with survival.
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Affiliation(s)
- Y Matsuda
- Department of Obstetrics and Gynaecology, Perinatal Medical Centre, Tokyo Women's Medical University Hospital, Tokyo, Japan
- Department of Obstetrics and Gynaecology, Kagoshima City Hospital, Kagoshima, Japan
| | - M Kamitomo
- Department of Obstetrics and Gynaecology, Kagoshima City Hospital, Kagoshima, Japan
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Abstract
Obstetric disorders account for 55% to 80% of admissions to the intensive care unit in the obstetric population. Medical conditions are emerging as the leading cause of maternal mortality, partly because of marked improvement in surgical and obstetric care in the developed world. The rise in maternal mortality related to medical conditions can be explained by multiple factors: improved medical care, women with chronic illnesses reaching childbearing years, older age at time of first pregnancy, improved reproductive technologies, and severe medical conditions exacerbated by the physiologic changes of pregnancy. This article reviews obstetric disorders leading to intensive care unit admissions.
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Affiliation(s)
- Ghada Bourjeily
- Department of Medicine, Pulmonary and Critical Care, Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02905, USA.
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Stein PD, Matta F, Yaekoub AY. Incidence of Amniotic Fluid Embolism: Relation to Cesarean Section and to Age. J Womens Health (Larchmt) 2009; 18:327-9. [DOI: 10.1089/jwh.2008.0974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paul D. Stein
- St. Joseph Mercy Oakland Hospital, Pontiac Michigan
- Wayne State University School of Medicine, Detroit, Michigan
| | - Fadi Matta
- St. Joseph Mercy Oakland Hospital, Pontiac Michigan
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Abstract
Sudden and unexpected natural deaths and nonnatural deaths may result from various pulmonary conditions. Additionally, several nonpulmonary conditions of forensic significance may be complicated by the development of respiratory lesions. Certain situations with pulmonary pathology are particularly likely to be critically scrutinized and may form the basis of allegations of medical negligence, other personal injury liability, or wrongful death.1
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Stehr SN, Liebich I, Kamin G, Koch T, Litz RJ. Closing the gap between decision and delivery—Amniotic fluid embolism with severe cardiopulmonary and haemostatic complications with a good outcome. Resuscitation 2007; 74:377-81. [PMID: 17379383 DOI: 10.1016/j.resuscitation.2007.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2006] [Revised: 12/10/2006] [Accepted: 01/05/2007] [Indexed: 11/22/2022]
Abstract
Perimortem caesarean section is very rare, mostly resulting in high mortality of mother and/or fetus. We report a case of successful resuscitation of both mother and newborn following maternal cardiac arrest prior to delivery. Postoperative outcome was complicated by severe bleeding and coagulopathy following fibrinolysis and subcapsular hepatic haematoma. We consider a fast reaction time based on a special in-hospital emergency team for immediate caesarean section and an aggressive management of coagulopathy as major factors that led to both patients recovery without neurological sequelae.
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Affiliation(s)
- Sebastian N Stehr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscher Str. 74, 01307 Dresden, Germany.
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Tramoni G, Boisson C, Gamerre L, Clement HJ, Bon C, Rudigoz RC, Viale JP. [Amniotic fluid embolism: a review]. ACTA ACUST UNITED AC 2006; 25:599-604. [PMID: 16630704 DOI: 10.1016/j.annfar.2006.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. It is a difficult and somewhat intangible diagnosis that warrants a high index of suspicion by physicians. AFE is an unpredictable, unpreventable, and, for the most part, an untreatable obstetric emergency. Management of this condition includes prompt recognition of the signs and symptoms, aggressive resuscitation efforts, and supportive therapy. Any delays in diagnosis and treatment can result in increased maternal and/or foetal impairment or death. Whereas once the invariable outcome of AFE was death of the mother, today the prognosis is somewhat brighter thanks to increased awareness of the syndrome and advances in intensive care medicine. No laboratory test is specific to attest the diagnosis and autopsy must to be realised in case of maternal death. Although non-specific, the diagnosis of AFE could be supported by the observation of amniotic fluid in the central venous blood as well as in the bronchoalveolar fluid. This easy and quick test will be helpful in decision-making. Prompt and aggressive supportive treatment is required to lessen an otherwise dismal outcome, which may include death and permanent disability. This article provides an account of the protean clinical features, pathogenesis, and principles involved in treatment.
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Affiliation(s)
- G Tramoni
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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Abstract
Amniotic fluid embolism is a rare syndrome that can have debilitating and lethal consequences. It is a difficult and somewhat intangible diagnosis that warrants a high index of suspicion by physicians. Prompt and aggressive supportive treatment is required to lessen an otherwise dismal outcome, which may include death and permanent disability. This article provides an account of the protean clinical features, pathogenesis, and principles involved in treatment.
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Affiliation(s)
- Imran Aurangzeb
- Division of Pulmonary and Critical Care Medicine, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA
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Tramoni G, Valentin S, Robert MO, Sergeant MV, Branche P, Duperret S, Clement HJ, Lopez F, Boisson C, Audra P, Rudigoz RC, Viale JP. Amniotic fluid embolism during caesarean section. Int J Obstet Anesth 2004; 13:271-4. [PMID: 15477060 DOI: 10.1016/j.ijoa.2004.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2004] [Indexed: 11/17/2022]
Abstract
Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. A high index of clinical suspicion is necessary to make an early diagnosis to reduce morbidity and mortality. We report a non-fatal case of amniotic fluid embolism occurring during a caesarean section, with special emphasis on the mode of development and diagnosis. The initial presentation of this syndrome was a coagulopathy, followed by the usual complications of massive bleeding. Although non-specific, the diagnosis of amniotic fluid embolism was supported by the observation of amniotic fluid in the central venous blood as well as in the broncho-alveolar fluid.
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Affiliation(s)
- G Tramoni
- Département d'anesthésie réanimation, Service d'obstétrique and Fédération de Biochimie, Hôpital de la Croix Rousse, and Service d'obstétrique, Hôpital Edouard Herriot, Pavillon K, Lyon, France.
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Mallampalli A, Powner DJ, Gardner MO. Cardiopulmonary resuscitation and somatic support of the pregnant patient. Crit Care Clin 2004; 20:747-61, x. [PMID: 15388200 DOI: 10.1016/j.ccc.2004.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiopulmonary arrest during pregnancy is a rare event that critical care clinicians must be prepared to manage. The causes of cardiopulmonary arrest during pregnancy, recommended modifications to cardiopulmonary resuscitation protocols that are specific to pregnancy, indications for and timing of perimortem cesarean delivery, and the expected fetal outcomes are reviewed. Rarely, brain death of a pregnant patient may occur in which continued support of the mother is possible to prolong the pregnancy and improve fetal outcome. Prolonged somatic support of pregnant patients who are brain dead presents specific management challenges, but has been accomplished. The physiologic changes that occur after brain death and recommendations for somatic support of the brain dead pregnant patient also are reviewed.
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Affiliation(s)
- Antara Mallampalli
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Ben Taub General Hospital, 1504 Taub Loop, 6th Floor, Houston, TX 77030, USA.
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Abstract
Intrapartum emergencies are challenging to all perinatal nurses because of the increased risk of adverse outcomes for the mother and fetus. Perinatal emergencies, such as seizures, amniotic fluid embolus, hemorrhage, and uterine rupture, create physiological challenges and trigger intrinsic survival techniques. The pregnant uterus becomes a vital source of blood volume during hypovolemic events because it is not considered a vital organ. The pregnancy itself may become burdensome, and birth may occur as an intrinsic maternal compensatory mechanism. The resultant fetal hypoxemia may also stress the fetus into initiating labor. During extensive oxygen desaturation and decompensation, the focus should be on maternal stabilization, which will subsequently enhance fetal stabilization. Clinical assessments, critical thinking, decision making, and resource allocation must be quick and appropriate to increase the likelihood of a positive outcome for the mother, fetus, and neonate.
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Affiliation(s)
- Carol A Curran
- Clinical Nurse Specialists and Associates, Virginia Beach, VA 23452, USA.
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Balazic J, Rott T, Jancigaj T, Popović M, Zajfert-Slabe M, Svigelj V. Amniotic fluid embolism with involvement of the brain, lungs, adrenal glands, and heart. Int J Legal Med 2003; 117:165-9. [PMID: 12732931 DOI: 10.1007/s00414-003-0368-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2002] [Accepted: 02/24/2003] [Indexed: 10/25/2022]
Abstract
The case of a healthy 31-year-old woman in the 40th week of second pregnancy is presented. During preparation for an emergency caesarean section, she developed an amniotic fluid embolism (AFE) with unusual and unique features. The acute onset of disease with cardiorespiratory failure with hypotension, tachycardia, cyanosis, respiratory disturbances and loss of consciousness, suggested at first a pulmonary thromboembolism, but the appearance of convulsions led to the diagnosis of AFE. The patient died after 5 days due to an untreatable brain edema. At autopsy, AFE with the usually associated disseminated intravascular coagulation was found in the lungs, brain, left adrenal gland, kidneys, liver and heart. Eosinophilic inflammatory infiltrates were found in the lungs, hepatic portal fields and especially in the heart, suggesting a specific hypersensitivity reaction to fetal antigens. Moreover, intravascular accumulation of macrophages in the lungs also favored a non-specific immune reaction to amniotic fluid constituents.
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Affiliation(s)
- J Balazic
- Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
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Abstract
The critical care aspects of obstetrics and pregnancy are varied and demand that critical care practitioners have a thorough knowledge of fetal and maternal changes in physiology as pregnancy progresses. Pregnancy can affect every organ system; and organ-specific conditions as well as syndromes that span multiple organ systems were described. Care of the critically ill, pregnant patient requires a true multidisciplinary approach for optimal outcomes. A review of the current concepts and suggestions for therapy were presented.
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Affiliation(s)
- Douglas F Naylor
- Department of Surgery, Michigan State University, College of Human Medicine, 3280 North Elms Road, Suite A, Flushing, MI 48433, USA.
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Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case-control study. BMJ (CLINICAL RESEARCH ED.) 2001; 322:1089-93; discussion 1093-4. [PMID: 11337436 PMCID: PMC31259 DOI: 10.1136/bmj.322.7294.1089] [Citation(s) in RCA: 462] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To estimate the incidence and predictors of severe obstetric morbidity. DESIGN Development of definitions of severe obstetric morbidity by literature review. Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case. SETTING All 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998. PARTICIPANTS 48 865 women who delivered during the time frame. RESULTS There were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment. CONCLUSION Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.
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Affiliation(s)
- M Waterstone
- Department of Public Health Medicine, Guy's, King's College, and St Thomas's Hospitals Schools of Medicine and Dentistry, Capital House, London SE1 3QD
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