Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass.
BACKGROUND
Amniotic fluid embolism is a rare yet often lethal peripartum complication resulting from rapid cardiovascular collapse. Progress toward a better understanding of this entity has failed to identify either the underlying hemodynamic pathophysiology or an effective evidence-based treatment.


METHODS
A 45-year-old woman with a documented placenta previa experienced an amniotic fluid embolism during scheduled cesarean delivery. Transesophageal echocardiogram examination revealed catastrophic pulmonary vasoconstriction. The use of cardiopulmonary bypass, heparin, epinephrine, and high-dose steroids resulted in a successful outcome.


CONCLUSIONS
Timely placement of transesophageal echocardiogram revealed catastrophic pulmonary vasoconstriction as the cause of circulatory collapse in a patient with amniotic fluid embolism, supporting the use of cardiopulmonary bypass as an effective intervention.
Stanten
Russell D
RD
Summit Medical Center, Oakland, California, USA.
Iverson
Leigh I G
LI
Daugharty
Terrance M
TM
Lovett
Stuart M
SM
Terry
Crystal
C
Blumenstock
Edward
E
D002315:Cardiopulmonary Bypass / Q000379:methods*; D002585:Cesarean Section; D003131:Combined Modality Therapy; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004619:Embolism, Amniotic Fluid / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012769:Shock / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome