Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization.
OBJECTIVE
To describe the anesthetic management of two cases of amniotic fluid embolus (AFE) and disseminated intravascular coagulation (DIC) who underwent bilateral uterine artery embolization to control their postpartum hemorrhage.


METHODS
We report the clinical course and management of two women who suffered sudden cardiorespiratory events during labour. The first patient had a cardiac arrest whereas the second developed respiratory failure and altered neurological status. They were diagnosed as having had an AFE. Both of these events were accompanied by severe postpartum hemorrhage and DIC. They suffered prolonged bleeding and received massive transfusions. Successful management of hemorrhage was optimized by uterine artery embolization, thus avoiding ongoing problems with bleeding and possible hysterectomy. The role of uterine artery embolization is described, along with its advantages and anesthetic considerations.


CONCLUSIONS
Women with severe postpartum hemorrhage, with or without DIC, should be considered for uterine artery embolization.
Goldszmidt
Eric
E
Department of Anesthesia, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada. e.goldszmidt@utoronto.ca
Davies
Sharon
S
D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001803:Blood Transfusion; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D018450:Disease Progression; D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000628:therapy; D004619:Embolism, Amniotic Fluid / Q000150:complications*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006323:Heart Arrest / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006473:Postpartum Hemorrhage / Q000209:etiology* / Q000628:therapy*; D011247:Pregnancy; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000209:etiology; D000077212:Ropivacaine
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl; D002045:Bupivacaine