Presumed antepartum amniotic fluid embolism.
BACKGROUND
Amniotic fluid embolism is seldom recognized in nonperipartum patients. The pathophysiology is uncertain and diagnosis imprecise, making management after stabilization difficult.


METHODS
A 37-year-old woman at 28 weeks' gestation presented with signs and symptoms consistent with amniotic fluid embolism including disseminated intravascular coagulopathy. A ventilation-perfusion scan demonstrated unmatched perfusion defects, but other radiographic studies were negative; the patient was treated with heparin. Four days after presentation she had spontaneous rupture of membranes followed by hypoxemia, necessitating cesarean delivery. A pulmonary arteriogram after the operation showed multiple filling defects; the patient was discharged on warfarin.


CONCLUSIONS
Amniotic fluid embolism is a difficult diagnosis to make, at best. Anticoagulation may be a therapeutic option.
Kent
Kristen J
KJ
Department of Obstetrics and Gynecology, Roy J. and Lucille A. Carver College of Medicine and The University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Cooper
Brian C
BC
Thomas
Karl W
KW
Zlatnik
Frank J
FJ
D000328:Adult; D000792:Angiography; D002585:Cesarean Section; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015150:Echocardiography, Doppler; D004619:Embolism, Amniotic Fluid / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology; D005500:Follow-Up Studies; D005865:Gestational Age; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011655:Pulmonary Embolism / Q000175:diagnosis*; D011659:Pulmonary Gas Exchange; D018570:Risk Assessment
D006493:Heparin