Amniotic fluid embolism with second trimester pregnancy termination: a case report.
OBJECTIVE
Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.


METHODS
A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.


CONCLUSIONS
It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors.
Ray
Barry K
BK
Department of Anesthesiology, Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Vallejo
Manuel C
MC
Creinin
Mitchell D
MD
Shannon
Kelly T
KT
Mandell
Gordon L
GL
Kaul
Bupesh
B
Ramanathan
Sivam
S
D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation; D004107:Dilatation and Curettage / Q000009:adverse effects*; D004619:Embolism, Amniotic Fluid / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005313:Fetal Death / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D008619:Mepivacaine / Q000627:therapeutic use; D008874:Midazolam / Q000627:therapeutic use; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000627:therapeutic use; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood; D015742:Propofol / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000627:therapeutic use
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D008619:Mepivacaine; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol