Abstract
Background
AFE (amniotic fluid embolism) is widely known as a disastrous rapid-progressing clinical entity. The incident ranges from 1:800 to 1:8,000. The mortality rate reaches 61–86%. Neonatal survival is reported at 70%.
Methods
We describe the case of a healthy 29-year old primigravida developing amniotic fluid embolism during labour. Acute respiratory failure and hypotension combined with seizures were the initial symptoms. The patient under went an urgent caesarean section with extreme blood loss, complicated by disseminated coagulopathy.
Results
A total hysterectomy was performed due to profuse bleeding. Aggressive management was practiced with continuous transfusion of blood products and administration of vasocopressors.
Conclusion
Amniotic fluid embolism or anaphylactoid syndrome of pregnancy is a life-threatening condition. Diagnosis is one of the exclusion. Its management is very difficult and requires quick management and cooperation of physicians from different specialities.
Similar content being viewed by others
References
Meyer JR (1926) Embolia pulmonar amnio caseosa. J Bras Med 2:301–303
Steiner PE, Lushbaugh CC (1941) Maternal pulmonary embolism by amniotic fluid. JAMA 117:1245–1254
Morgan M (1979) Amniotic fluid embolism. Anaesthesia 34:20–32
Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF (1995) Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 172:1158–1167
Tuffnell DJ (2005) United Kingdom amniotic fluid embolism register. BJOG 112:1625–1629
Girard P, Mal H, Laine JP et al (1986) Left heart failure in amniotic fluid embolism. Anesthesiology 64:262–265
Turner R, Gusack M (1984) Massive amniotic fluid embolism. Ann Emerg Med 13:359–361
Harnett MJP, Hepner DL, Datta S et al (2005) Effect of amniotic fluid on coagulation and platelet function in pregnancy: an evaluation using thromboelastography. Anaesthesia 60:1068–1072
Estelles A, Gilabert J, Andres C et al (1990) Plasminogen activator inhibitors type 1 and type 2 and plasminogen activators in amniotic fluid during pregnancy. Thromb Haemost 64:281–285
Karetzky M, Ramirez M (1998) Acute respiratory failure in pregnancy. An analysis of 19 cases. Medicine 77:41–49
Roche WD Jr, Norris HJ (1974) Detection and significance of maternal pulmonary amniotic embolism. Obstet Gynecol 43:729–731
Kramer MS, Rouleau J, Baskett TF, Joseph KS, The Maternal Health Study Group of the Canadian Perinatal Surveillance System (2006) Amniotic fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet 368(9545):1444–1448
Clark SL, Pavlova Z, Geenspoon J, Horenstein J, Phelan JP (1986) Squamous cells in the maternal pulmonary circulation. Am J Obstet Gynecol 154:104–106
Kanayama N, Yamazaki T, Naruse H, Sumimoto K, Horiuchi K, Terao T (1992) Determining zinc coproporphyrin in maternal plasma—a new method for diagnosing amniotic fluid embolism. Clin Chem 38:526–529
Kobayashi H, Ohi H, Terao T (1993) A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc 2-6GalNAc. Am J Obstet Gynecol 168:848–853
Benson MD, Lindberg RE (1996) Amniotic fluid embolism, anaphylaxis, and tryptase. Am J Obstet Gynecol 175:737
James CF, Feinglass NG, Menke DM et al (2004) Massive amniotic fluid embolism: diagnosis aided by emergency transesophageal echocardiography. Int J Obstet Anesth 13:279–283
Lim Y, Loo CC, Chia V et al (2004) Recombinant factor VIIa after amniotic fluid embolism and disseminated intravascular coagulopathy. Int J Obstet Anesth 87:178–179
Stanten RD, Iverson LI, Daugharty TM et al (2003) Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass. Obstet Gynecol 102:496–498
O’Shea A, Eappen S (2007) Amniotic fluid embolism. Int Anesthesiol Clin 45(1):17–28
Hsieh YY, Chang CC, Li PC et al (2000) Successful application of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsion as lifesaving therapy for a patient with amniotic fluid embolism. Am J Obstet Gynecol 183:496–497
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Peitsidou, A., Peitsidis, P., Tsekoura, V. et al. Amniotic fluid embolism managed with success during labour: report of a severe clinical case and review of literature. Arch Gynecol Obstet 277, 271–275 (2008). https://doi.org/10.1007/s00404-007-0489-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-007-0489-z