Her heart rate decreased to 40/min, oxygen saturation dropped to 44% on room air, and the patient exhibited decorticate posturing. Approximately 15 minutes after delivery, while the subcutaneous tissue closure was being completed, the patient complained of a feeling of impending doom. Delivery of the neonate and placenta was uneventful. Upon admission, the patient was taken to the operating room for the planned procedure under regional anesthesia. Her medical history was otherwise uncomplicated. The patient's pregnancy was complicated by chronic hypertension, but she required no medication during pregnancy. In this case, the patient survived after prolonged cardiac arrest and is neurologically intact.Ī 34-year-old gravida 4, para 2012 presented for a scheduled repeat cesarean section and bilateral tubal ligation at 39 weeks of gestation. We present a case of presumed AFE causing immediate postpartum cardiac arrest and the use of the AOK adjunctive protocol. However, very few documented case reports show the utility and success of AOK for treatment of AFE. 3 The use of atropine (1 mg intravenously ), ondansetron (8 mg IV), and ketorolac (30 mg IV) (AOK) as an adjunctive treatment is widely discussed by obstetric providers as a treatment option that should be considered to supplement other treatment modalities. 1 Current guidelines for management of AFE focus on combating acute right heart failure and subsequent cardiogenic shock due to left heart failure. The activation of these substances leads to multiple detrimental physiologic changes resulting in pulmonary artery hypertension, acute cor pulmonale, and eventual complete cardiovascular collapse. 1, 2 AFE is hypothesized to occur when amniotic fluid enters the maternal circulation, causing massive constriction of the pulmonary vessels from the activation of physiologic mediators such as histamine, endothelin, and leukotrienes. Risk factors for AFE include advanced maternal age (35 years or older), cesarean or operative delivery, placental abnormalities, and eclampsia. 2014 Feb 21 111(8):126-32.Amniotic fluid embolism (AFE) is a rare cause of severe maternal morbidity and mortality. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment. Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section. Kramer MS, Rouleau J, Baskett TF, Joseph KS, Maternal Health Study Group of the Canadian Perinatal Surveillance System Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Amniotic fluid embolism: analysis of the national registry.
2015 May 28(7):793-8.Ĭlark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: antepartum, intrapartum and demographic factors.
Other causes of hemodynamic instability should be ruled out.Ĭopyright © 2023, StatPearls Publishing LLC.įong A, Chau CT, Pan D, Ogunyemi DA. The diagnosis is of exclusion based on clinical presentation. The diagnosis of AFE has been established at autopsy when fetal squamous cells are found in the maternal pulmonary artery blood however, fetal squamous cells are also sometimes present in the circulation of laboring women who do not develop AFE. Data from the National Amniotic Fluid Embolism Registry suggests that the process resembles anaphylaxis more than embolism, and the terminology of "anaphylactoid syndrome of pregnancy" has been recommended because fetal tissue or amniotic fluid components are not always found in women who present with signs and symptoms attributable to amniotic fluid embolism. Steiner and Luschbaugh first described amniotic fluid embolism in 1941, after they found fetal cells in the maternal pulmonary circulation, who died during labor.
In the United States, AFE occurs in 2 to 8 per 100,000 deliveries and is the cause of maternal mortality between 7.5% to 10%. Survivors are frequently left with serious cardiac, renal, neurologic, and pulmonary dysfunction. The presentation is abrupt, usually with sudden cardiorespiratory collapse followed by severe coagulopathy and refractory resuscitation. Amniotic fluid embolism (AFE) represents the second leading cause of peripartum maternal death in the United States and the number one cause of peripartum cardiac arrest. Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency characterized by sudden cardiorespiratory collapse and disseminated intravascular coagulation.
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