Amniotic Fluid Embolism.

Amniotic Fluid Embolism (AFE) is a potentially fatal rare obstetric complication. In this paper, the death of a 30-year old apparently healthy parturient due to AFE is reported. She underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia but after about half an hour of the operative procedure, she developed features of Acute Respiratory Distress Syndrome (ARDS) and shock, and died within five hours of the onset of the symptoms. The sudden death of an apparently healthy parturient may lead to medical negligence claims by the relatives. In developing countries, it still remains a post-mortem diagnosis and in the present case, histopathological examination findings helped in coming to a conclusive opinion of AFE.

Diagnosis of amniotic fluid embolism with blood samples by liquid-based cytology technique / 法医学杂志

OBJECTIVE@#To establish the diagnosis of amniotic fluid embolism with blood samples by liquid-based cytology technique and to study the validity of method.@*METHODS@#The blood samples were collected from patients who suffered from amniotic fluid embolism. The components of amniotic fluid in blood samples were examined with blood smear by two direct smear methods (supernatant smear, sediment smear) and two liquid-based cytology methods (automatic smear, manual smear). The positive detection rate of each method was calculated.@*RESULTS@#The positive detection rates of two liquid-based cytology methods (84.6% and 92.3%, respectively) were much higher than those of two direct methods (53.8% and 61.5%, respectively).@*CONCLUSION@#The liquid-based cytology technique could improve the positive detection rate of amniotic fluid embolism.

Sudden cardiac arrest during cesarean section - a possible case of amniotic fluid embolism

Amniotic Fluid Embolism [AFE] is a rare obstetric catastrophe that occurs in approximately 1/50,000 pregnancies and has a mortality rate in excess of 80%. AFE is a condition that is poorly understood and often difficult to diagnose. We report a case of a healthy 27 yr-old gravid two, 35 wk gestation parturient with a previous Cesarean section two years previously, and presently admitted for emergent Cesarean section due to premature uterine contractions. Induction of general anesthesias was performed with no problem and a male preterm infant with Apgar 8 at 1min was delivered. Amniotic fluid was bloody and 40% placental abruption existed. Following delivery of the placenta, patient suddenly became plethoric and O2 saturation began to decrease and no pulse could be palpated! Immediate CPR was successful but she was hemodynamically unstable and signs of right heart strain was obvious. Right jugular venous catheterization was performed, vasopressors were administered. After a two hours period of relatively stable vital signs, patient's reflexes returned to normal, however, profound coagulopathy on lab data was reported and she was treated with 10 unit Packed Red Blood Cells [PRBCs], 10 unit FFP and 8 unit platelets, Sodium bicarbonate, oxytocin and Methergine. The patient remained hemodynamically unstable while laparotomy-hysterectomy was performed to stop the bleeding. Unfortunately attempts were unsuccessful and patient died four hours later in ICU. Post-mortem findings showed signs of Disseminated Intravascular Coagulation [DIC], no fetal squamous cells in pulmonary vasculature were found and special staining of Cytokeratin marker shows no positive cells in lumen of vessels. The post-mortem diagnosis of AFE is challenging to forensic investigators and pathologists and can be confirmed by histological confirmation of amniotic fluid contents in the pulmonary vasculature, although they may be difficult to identify. In recent years it has been suggested that AFE is an anaphylactoid reaction to fetal antigens and an elevated serum tryptase level is increasingly being used to support the diagnosis. Sudden onset of cardiovascular collapse and early signs of right heart strain and fulminant DIC supports the diagnosis of AFE in this case, although no fetal debri could be find in pathologic staining

Embolia de líquido amniótico: Criterio diagnóstico en dos casos fatales / Amniotic fluid embolism: Diagnostic criteria in two fatal cases

La embolia de líquido amniótico continúa siendo una causa importante de mortalidad materna. Presentamos la información obtenida por medio de la cateterización cardíaca derecha y la ecocardiografía, en dos pacientes que desarrollaron embolia de líquido amniótico y fallecieron por shock y coagulación intravascular diseminada a pesar del tratamiento intensivo. Aunque la fisiopatología continúa siendo discutida, la embolia por líquido amniótico se puede diagnosticar y manejar a partir de los valores hemodinámicos y el ecocardiograma.

Amniotic fluid embolism still remains an important cause of maternal mortality. We present information obtained by echocardiography and right cardiac catheterization of two patients who developed amniotic fluid embolism and died from shock and disseminated intravascular coagulation despite intensive medical treatment. Although the pathophysiology remains controversial, amniotic fluid embolism can be presumptively diagnosed and managed with hemodynamic values and echocardiography.

Embolia de liquido amniótico — relato de caso / Amniotic fluid embolism — a case report

A embolia de liquido amniótico continua sendo complicação da gravidez de elevada mortalidade, impossível de ser prevenida. O seu diagnóstico é essencialmente clínico e de exclusão, uma vez que os exames para o seu diagnóstico definitivo carecem de especificidade e sensibilidade. O seu manejo baseia-se em medidas suportivas. devendo ser feito, de preferência, em centros de tratamento intensivo, com monitorização invasiva adequada. Neste artigo, é relatado o caso de uma paciente de 31 anos com todos os elementos clínicos para o diagnóstico de embolia de liquido amniótico e cujo tratamento intensivo resultou em melhora.

Amniotic fluid embolism

Amniotic fluid embolism, although fortunately rare, is one of the most catastrophic situations in obstetrics. It cannot be predicted nor prevented. The clinical events in this syndrome include respiratory failure, cardiopulmonary collapse, and disturbances of the clotting mechanism. Maintenance of oxygenation, circulatory support and correction of the coagulopathy can be life saving. Although maternal and fetal prognosis is grave, death need not be the inevitable outcome if diagnosis is made early and is followed by prompt and aggressive management. Future efforts must be directed towards more clearly delineating the presentation, pathogenesis, diagnosis and outcome of amniotic fluid embolism

Sudden maternal deaths from amniotic fluid embolism.

Sudden maternal death from amniotic fluid embolism is a rare but serious complication which usually occurs during late pregnancy, often during labour or shortly after, with more than 80% mortality. Such a death causes immense stress to both the relatives and the attending doctors as it is sudden and unexpected. Three such deaths are discussed here. Traditionally, it was believed that this complication usually occurred in prolonged and difficult labour, but there is evidence contrary to this, and it is not possible to predict when and where this fatal complication will occur. Current views and various pathophysiologic mechanisms leading to the fatal outcome are also discussed.

Embolia por líquido amniótico / Embolism by amniotic fluid

Embolism By amniotic fluid is a rare event, with a high level of maternal death. The pathogenesis is still obscure and subjected to a supporting treatment only. This paper aimed at developing a bibliographic review based on a personal case reported

Amniotic fluid embolism: a case report.

A case of a 27-year-old, gravida 1, para 0 whose labor was induced with prostaglandin and followed by syntocinon was reported. During labor, she developed amniotic fluid embolism and died.