Title: Amniotic Fluid Embolism: A Nightmare
Authors: Dr Rashmi Bengali, Dr Tushar Patil, Dr Niyati Arora
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.37
The disastrous entry of amniotic fluid into the maternal circulation leads to dramatic sequelae of clinical events, characteristically referred to as Amniotic fluid embolism (AFE). AFE can occur during labour, caesarean section, dilatation and evacuation or in the immediate postpartum period where the role of anaesthetist is prudent. The pathophysiology is believed to be immune mediated which affects the respiratory, cardiovascular, neurological and haematological systems. Undetected and untreated, it turns into fulminant pulmonary oedema, intractable convulsions, disseminated intravascular coagulation (DIC), malignant arrhythmias and cardiac arrest. Usually the diagnosis is made clinically however definite diagnosis can be confirmed by identification of lanugo, foetal hair and foetal squamous cells in blood aspirated from the maternal right ventricle. The cornerstone of management is early recognition and aggressive resuscitation with multidisciplinary approach that increases the probability of maternal and neonatal survival. Keywords: Amniotic fluid embolism, pulmonary oedema, hypoxia, coagulopathy, cardiac arrest 1. Morgan M. Amniotic fluid embolism. Anesthesia. 1979;30:20–6. 2. Meyer JR. Emboliapulmonaramnio-caseosa. Braz Med. 1926;2:301–3. 3. Steiner PE, Lushbaugh CC. Maternal pulmonary embolism by fluid as a cause of obstetric shock and unexpected deaths in obstetrics. JAMA. 1941;117:1245–54. 4. Clarke SL, Hankins G, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: Analysis of the national registry. Am J Obstet Gynecol. 1995;172:1158–67 5. Hankikns GD, Snyder RR, Clarke SL, Schwartz L, Patterson WR, Clifford A. Acute hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goat model. Am J Obstet Gynecol.1993;168:1113–30 6. Clark SL. New concepts of amniotic fluid embolism: A review. Obstet Gynecol Surv. 1990; 45:360–8 7. . Reeves WC, Demers LM, Wood MA, Skarlatos S, Copenhaver G, Whitesell L, et al. The release of thromboxane A2 and prostacyclin following experimental acute pulmonary embolism. Prostaglandins Leukot Med. 1983;11:1–10. 8. Christiansen LR, Collins KA: Pregnancy-associated deaths: A 15-year retrospective study and overall review of maternal pathophysiology. Am J Forensic Med Pathol 2006; 27:11–9 9. Gei G, Hankins GD. Amniotic fluid embolism: An update. Contemporary OB/GYN. 2000;45:53–62 10. Hassart TH, Essed GG. Amniotic fluid embolism after transabdominal amniocen-tesis. Eur J Obstet Gynecol Reprod Biol. 1983;16:25–30. 11. Ray BK, Vallejo MC, Creinin MD, Shannon KT, Mandell GL, Kaul B, et al. Amniotic fluid embolish with second trimester pregnancy termination: A case report. Can J Anesth. 2004;51:139–44 12. Maher JE, Wenstorm KD, Hauth JC, Meis PJ. Amniotic fluid embolism after saline amnioinfusion: Two cases and a review of the literature. Obstet Gynecol. 1994; 83: 851–4. 13. Gogola J, Hankins GD. Amniotic fluid embolism in progress: A management dilemma. Am J Perinatol. 1998;15:491–3. 14. Sperry K. Landmark perspective: Amniotic embolism. To understand an enigma. JAMA.1986;255:2183–6. 15. Oi H, Kobayashi H, Hirashima Y, Yamazaki T, Kobayashi T, Terao T. Serological and immunohistochemical diagnosis of amniotic fluid embolism. Semin Thromb Hemost. 1998;24:479–84 16. Kanayama N, Yamazaki T, Naruse H, Sumimoto K, Horiuchi K, Terao T. Determining zinc coproporphyrin in maternal plasma-A new method for diagonising amniotic fluid embolism. Clin Chem. 1992;38:526–9 17. Karetzky M, Ramirez M. Acute respiratory failure in pregnancy. An analysis of 19 cases.Medicine. 1998;77:71–9. 18. Gogola J, Hankins GD. Amniotic fluid embolism in progress: A management dilemma. Am J Perinatol. 1998;15:491–3. 19. 13Stanten RD, Iverson LI, Daugharty TM, Lovett SM, Terry C, Blumenstock E: Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: Diagnosis by transesophageal echocardi-ogram and treatment by cardiopulmonary bypass. ObstetGynecol 2003; 102:496–8 20. James CF, Feinglass NG, Menke DM, Grinton SF, Papadimos TJ. Massive amniotic fluid embolism: Diagnosis aided by emergency transesophageal echo cardi-ography. Int J Obstet Anesth.04;13:279–83 21. McDonnell NJ, Chan BO, Frengley RW. Rapid reversal of critical haemodynamic compromise with nitric oxide in a partur-ient with amniotic fluid embolism. Int J Obstet Anesth. 2007; 16:269–73.Abstract
References