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1.
Medicine (Baltimore) ; 99(4): e18951, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977912

RESUMO

RATIONALE: An amniotic fluid embolism (AFE) is a rare, lethal syndrome that is commonly associated with disseminated intravascular coagulation (DIC). Anticoagulation therapy is the most important strategy to inhibit excessive activation of the coagulation cascade in patients with AFE and DIC. At present, treatment of AFE with rivaroxaban has not been reported. PATIENT CONCERNS: We report a 37-year-old woman (gravida 2, para 1) at 39 weeks' gestation with irregular contractions of the uterus was admitted to the obstetrical department. Ten minutes after the spontaneous rupture of the membranes, the patient complained of dyspnea and dysphoria and exhibited cyanosis of her lips. The patient's blood pressure decreased and heart rate increased rapidly, and 2100 mL of unclotted blood flowed from her vagina within 1 hour. Her platelet count dropped to 21 × 10/L, and the results from routine coagulation tests, and D-dimer and fibrin degradation product tests were obviously abnormal. DIAGNOSES: According to the current research consensus, AFE with DIC should be considered immediately when sudden cardiovascular collapse occurs around the time of labor and delivery, followed by the development of coagulopathy and hemorrhage. INTERVENTIONS: In addition, the variety of supportive treatments, rivaroxaban was used in anticoagulant therapy. OUTCOMES: At follow-up 30 and 60 days, there were no complaints of discomfort or abnormal laboratory assays. The patient recovered completely. LESSONS: This case highlights that rivaroxaban, as a direct inhibitor of activated factor Xa, demonstrates a good therapeutic efficacy for treating AFE with DIC.


Assuntos
Coagulação Intravascular Disseminada/tratamento farmacológico , Embolia Amniótica/tratamento farmacológico , Inibidores do Fator Xa/administração & dosagem , Rivaroxabana/administração & dosagem , Adulto , Transfusão de Eritrócitos , Feminino , Humanos , Gravidez , Resultado do Tratamento
2.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
3.
PLoS Med ; 16(11): e1002976, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31714903

RESUMO

In a Perspective, Sarka Lisonkova and Michael Kramer discuss the accompanying study by Kathryn Fitzpatrick and co-authors on management of amniotic fluid embolism.


Assuntos
Embolia Amniótica , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Gravidez , Fatores de Risco
4.
PLoS Med ; 16(11): e1002962, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31714909

RESUMO

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.


Assuntos
Embolia Amniótica/etiologia , Embolia Amniótica/terapia , Adulto , Austrália/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Incidência , Modelos Logísticos , Mortalidade Materna/tendências , Países Baixos/epidemiologia , Razão de Chances , Gravidez , Fatores de Risco , Eslováquia/epidemiologia , Inquéritos e Questionários , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento , Reino Unido/epidemiologia
8.
Emerg Med Clin North Am ; 37(2): 287-300, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940373

RESUMO

This article covers a high-risk time in a woman's life, the period just after delivery of her baby. There are large variations in complication rates across various groups in the United States. Many women seek care in the emergency department for routine and more serious postpartum pathologies. Emergency physicians should be well versed in common and life-threatening complications of delivery. The specific pathologies discussed in this article include lactation in the emergency department, postpartum hemorrhage, amniotic fluid embolism, endometritis, and mastitis.


Assuntos
Transtornos Puerperais/diagnóstico , Embolia Amniótica/diagnóstico , Embolia Amniótica/terapia , Serviço Hospitalar de Emergência , Endometrite/diagnóstico , Endometrite/terapia , Feminino , Humanos , Transtornos da Lactação/diagnóstico , Transtornos da Lactação/terapia , Mastite/diagnóstico , Mastite/terapia , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/terapia , Gravidez , Transtornos Puerperais/terapia
9.
Emerg Med Clin North Am ; 37(2): 351-363, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940377

RESUMO

Many health care providers lack familiarity with maternal physiologic changes and the distinctive underlying etiology of cardiac arrest in pregnancy. Knowledge of what changes are expected in pregnancy and an understanding of how to adapt clinical practice is essential for the care of the pregnant woman in the emergency department. Amniotic fluid embolism should be recognized as a rare cause of cardiac arrest in pregnancy, characterized by the triad of cardiovascular collapse, hypoxic respiratory failure, and coagulopathy. Cardiopulmonary resuscitation should follow standard AHA ACLS guidelines. Resuscitative hysterotomy may be attempted to restore perfusion to both mother and fetus.


Assuntos
Serviço Hospitalar de Emergência , Complicações na Gravidez/terapia , Ressuscitação , Manuseio das Vias Aéreas , Reanimação Cardiopulmonar , Cesárea , Embolia Amniótica/diagnóstico , Embolia Amniótica/terapia , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Humanos , Gravidez/fisiologia
11.
A A Pract ; 13(2): 74-77, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30864952

RESUMO

Amniotic fluid embolism is a rare but dreaded complication of pregnancy, with an incidence between 2 and 7/100,000 deliveries. We report an amniotic fluid embolism after urgent cesarean delivery diagnosed on a cardiac arrest, complicated by cardiogenic shock and acute respiratory distress syndrome. This report describes the indication, efficacy, and success of venoarterial extracorporeal membrane oxygenation in the early management of cardiac arrest, cardiac failure driven by amniotic fluid embolism, and acute respiratory distress syndrome. The use of venoarterial extracorporeal membrane oxygenation support after recovery from cardiac arrest after amniotic fluid embolism should be considered early during the management of these cases.


Assuntos
Embolia Amniótica/terapia , Parada Cardíaca/terapia , Complicações Cardiovasculares na Gravidez/terapia , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Cesárea , Embolia Amniótica/etiologia , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Gravidez , Síndrome do Desconforto Respiratório do Adulto/etiologia , Resultado do Tratamento
12.
J Gynecol Obstet Hum Reprod ; 48(5): 309-314, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30796984

RESUMO

The incidence of maternal cardiac arrest ranges from 1/55,000 to 1/12,000 births. It is due most frequently to cardiovascular, hemorrhagic, and anesthesia-related causes, as well as to amniotic fluid embolism. The basic principles of resuscitation remain applicable in this situation, but the physiological modifications of pregnancy must be taken into account, in particular, the aortocaval compression syndrome. After 24 weeks of gestation, a salvage cesarean delivery must be performed immediately, without transfer to the operating room, if resuscitation maneuvers have failed 4 min after arrest, because this interval conditions the mother's neurological prognosis and improves neonatal survival.


Assuntos
Parada Cardíaca/terapia , Hospitalização , Complicações Cardiovasculares na Gravidez/terapia , Suporte Vital Cardíaco Avançado , Reanimação Cardiopulmonar , Cesárea , Embolia Amniótica , Oxigenação por Membrana Extracorpórea , Feminino , Parada Cardíaca/etiologia , Humanos , Incidência , Parto , Gravidez , Prognóstico , Fatores de Risco
13.
J Matern Fetal Neonatal Med ; 32(8): 1262-1266, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29166810

RESUMO

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.


Assuntos
Anestesia/métodos , Embolia Amniótica/diagnóstico , Embolia Amniótica/terapia , Adulto , Anestesia Obstétrica/métodos , Bradicardia , Cesárea , Estudos de Coortes , Parto Obstétrico , Embolia Amniótica/mortalidade , Feminino , Doenças Fetais , Humanos , Trabalho de Parto , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/terapia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Cardiovasculares na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Estudos Retrospectivos , Resultado do Tratamento , Inconsciência
15.
Curr Probl Diagn Radiol ; 48(4): 387-392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30232041

RESUMO

Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia Amniótica/diagnóstico por imagem , Embolia Gordurosa/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Diagnóstico Diferencial , Embolia Amniótica/diagnóstico , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Pulmão , Imagem por Ressonância Magnética/métodos , Masculino , Gravidez , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Medição de Risco , Tomografia Computadorizada por Raios X/métodos
17.
Int J Obstet Anesth ; 38: 127-130, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30279053

RESUMO

Amniotic fluid embolism is a rare but often catastrophic emergency. The non-specific clinical features and lack of diagnostic tests make it a diagnosis of exclusion. Point-of-care visco-elastometric testing is being increasingly used during obstetric haemorrhage. We present a case of amniotic fluid embolism, diagnosed and managed using rotational thromboelastography. During a precipitous labour, a 21-year-old multiparous woman became pale, distressed and disorientated. The fetus was delivered using forceps. Simultaneously maternal cardiac arrest occurred and advanced life support was commenced. As there was no obvious bleeding, pulmonary embolism was considered the most likely diagnosis and preparation was made to thrombolyse. During resuscitation, rotational thromboelastometry demonstrated haemostatic failure, supporting a diagnosis of amniotic fluid embolism. This reversed the decision to thrombolyse and focused the team on resuscitation and management of coagulopathy. Targeted blood products were given using a local protocol specific to obstetric bleeding. Return of cardiac output was achieved. The total measured blood loss was more than 3.6 L and transfusion was guided by point-of-care tests. Transfused blood products were six units of packed red blood cells, one pool of platelets, 12 units of fresh frozen plasma and 14 g of fibrinogen concentrate. This case demonstrates amniotic fluid embolism with haemostatic failure, without initial revealed blood loss. The high mortality of amniotic fluid embolism necessitates rapid diagnosis and aggressive management. Laboratory tests in this context are impractical in informing clinical decisions, showing the value of point-of-care testing in facilitating team work and timely administration of targeted blood products.


Assuntos
Coagulantes/uso terapêutico , Embolia Amniótica/diagnóstico , Embolia Amniótica/tratamento farmacológico , Tromboelastografia/métodos , Adulto , Carboprosta/uso terapêutico , Reanimação Cardiopulmonar , Feminino , Fibrinogênio/uso terapêutico , Parada Cardíaca/terapia , Humanos , Recém-Nascido , Masculino , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Plasma , Gravidez , Adulto Jovem
18.
BJOG ; 126(3): 394-401, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28755459

RESUMO

OBJECTIVE: Develop a core outcome set of international consensus definitions for severe maternal morbidities. DESIGN: Electronic Delphi study. SETTING: International. POPULATION: Eight expert panels. METHODS: All 13 high-income countries represented in the International Network of Obstetric Surveillance Systems (INOSS) nominated five experts per condition of morbidity, who submitted possible definitions. From these suggestions, a steering committee distilled critical components: eclampsia: 23, amniotic fluid embolism: 15, pregnancy-related hysterectomy: 11, severe primary postpartum haemorrhage: 19, uterine rupture: 20, abnormally invasive placentation: 12, spontaneous haemoperitoneum in pregnancy: 16, and cardiac arrest in pregnancy: 10. These components were assessed by the expert panel using a 5-point Likert scale, following which a framework for an encompassing definition was constructed. Possible definitions were evaluated in rounds until a rate of agreement of more than 70% was reached. Expert commentaries were used in each round to improve definitions. MAIN OUTCOME MEASURES: Definitions with a rate of agreement of more than 70%. RESULTS: The invitation to participate in one or more of eight Delphi processes was accepted by 103 experts from 13 high-income countries. Consensus definitions were developed for all of the conditions. CONCLUSION: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process. These should be used in national registrations and international studies, and should be taken up by the Core Outcomes in Women's and Newborn Health initiative. TWEETABLE ABSTRACT: Consensus definitions for eight morbidity conditions were successfully developed using the Delphi process.


Assuntos
Eclampsia , Embolia Amniótica , Parada Cardíaca , Hemoperitônio , Histerectomia , Doenças Placentárias , Hemorragia Pós-Parto , Ruptura Uterina , Consenso , Técnica Delfos , Países Desenvolvidos , Feminino , Humanos , Cooperação Internacional , Gravidez , Complicações na Gravidez , Complicações Cardiovasculares na Gravidez , Garantia da Qualidade dos Cuidados de Saúde , Índice de Gravidade de Doença
20.
Sud Med Ekspert ; 61(6): 48-51, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30499477

RESUMO

The authors report two cases of extended amniotic fluid embolism (AFE) associated with the birth-giving process with the analysis of their causes and the discussion of the possible pathways through which the amniotic fluid penetrates into maternal blood. A rare cause of amniotic fluid embolism due to the rupture of placental membranes as a result of submembranous hemorrhage is described. The changes in the lungs associated with extended AFE are apparent in the presence of macroscopic emboli formed from the particles of the amniotic fluid. The article describes for the first time in the Russian-language literature the macroscopically visible emboli composed of the particles of the amniotic fluid present in the pulmonary blood vessels. It is also the first report of the rupture of the placental membranes resulting from subamniotic hemorrhage as a cause of the appearance of the amniotic fluid in the maternal circulation.


Assuntos
Embolia Amniótica/diagnóstico , Hemorragia/diagnóstico , Pulmão/patologia , Placenta/patologia , Feminino , Humanos , Gravidez
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