Abstract
Purpose
Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.
Clinical features
A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.
Conclusions
It is now recognized that the pathophysiological features of AFE are similar to a type-I hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors.
Résumé
Objectif
Décrire le diagnostic, les éléments cliniques, la physiopathologie, le traitement et les mesures anesthésiques entourant une embolie amniotique (EA) chez une patiente qui a subi une interruption de grossesse au deuxième trimestre.
Éléments cliniques
Une femme de 30 ans, G2 P1, a été admise pour subir une dilatation et une évacuation pour mort fœtale pendant le deuxième trimestre de la grossesse. Hypotension, choc, arrêt respiratoire, dissociation électromécanique, hémorragie, coagulopathie intravasculaire disséminée nécessitant une réanimation cardio-pulmonaire et une transfusion sanguine ont compliqué les soins peropératoires. L’EA a été considérée comme la cause la plus probable de cet événement peropératoire.
Conclusions
On sait maintenant que les caractéristiques physiopathologiques d’une EA sont similaires à une réaction d’hypersensibilité de type I allant d’une réaction bénigne généralisée à l’anaphylaxie et au choc. L’EA présente un taux élevé de morbidité et de mortalité maternelles et fœtales qui nécessitent une identification et un traitement rapides. En cas d’instabilité cardiovasculaire, le traitement de l’EA est semblable à celui de l’anaphylaxie et requiert une hydratation liquide importante, une réanimation cardio-pulmonaire, l’administration de dérivés sanguins et l’usage de vasopresseurs.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 1995; 172: 1158–69.
Morgan M. Amniotic fluid embolism. Anaesthesia 1979; 34: 20–32.
Cromey MG, Taylor PJ, Cumming DC. Probable amniotic fluid embolism after first-trimester pregnancy termination. A case report. J Reprod Med 1983; 28: 209–11.
de Swiet M. Maternal mortality: confidential enquiries into maternal deaths in the United Kingdom. Am J Obstet Gynecol 2000; 182: 760–6.
Lawson HW, Atrash HK, Franks AL. Fatal pulmonary embolism during legal induced abortion in the United States from 1972 to 1985. Am J Obstet Gynecol 1990; 162: 986–90.
Sharma SK, Lechner RB. Hematologic and coagulation disorders. In: Chestnut DH (Ed.). Obstetric Anesthesia. Principles and Practice, 2nd ed. St. Louis: Mosby Inc.; 1999: 842–59.
Steiner PE, Lushbaugh CC. Maternal pulmonary embolism by amniotic fluid. JAMA 1941; 117: 1340–5.
American College of Obstetricians and Gynecologists. Obstetric emergencies. In: Prolog: Obstetrics, 5th ed. Washington, DC; 2003: 27.
Clark SL, Pavlova Z, Geenspoon J, Horenstein J, Phelan JP. Squamous cells in the maternal pulmonary circulation. Am J Obstet Gynecol 1986; 154: 104–6.
Martin RW. Amniotic fluid embolism. Clin Obstet Gynecol 1996; 39: 101–6.
Shechtman M, Ziser A, Markovits R, Rozenberg B. Amniotic fluid embolism: early findings of transesophageal echocardiography. Anesth Analg 1999; 89: 1456–8.
Kanayama N, Yamazaki T, Naruse H, Sumimoto K, Horiuchi K, Terao T. Determining zinc coproporphyrin in maternal plasma—a new method for diagnosing amniotic fluid embolism. Clin Chem 1992; 38: 526–9.
Kobayashi H, Ohi H, Terao T. A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc α2-6GalNAc. Am J Obstet Gynecol 1993; 168: 848–53.
Esposito RA, Grossi EA, Coppa G, et al. Successful treatment of postpartum shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy. Am J Obstet Gynecol 1990; 572–4.
Hogberg U, Joelsson I. Amniotic fluid embolism in Sweden, 1951–1980. Gynecol Obstet Invest 1985; 20: 130–7.
Levy JH. The allergic response. In: Barash PG, Cullen BF, Stoelting RK (Eds.). Clinical Anesthesia, 3rd ed. Philadelphia: Lippincott-Raven Publishers; 1997: 1205–17.
Cummins RO. ACLS Provider Manual. Dallas: American Heart Association; 2001.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ray, B.K., Vallejo, M.C., Creinin, M.D. et al. Amniotic fluid embolism with second trimester pregnancy termination: a case report. Can J Anesth 51, 139–144 (2004). https://doi.org/10.1007/BF03018773
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03018773