Massive amniotic fluid embolism: diagnosis aided by emergency transesophageal echocardiography.
A 36-year-old woman was hospitalized at term and in labor at 3-cm cervical dilatation. The early labor course was remarkable only for oxytocin augmentation and combined spinal-epidural analgesia. Eight hours after admission, tetanic uterine contractions ensued, followed by persistent fetal bradycardia. An emergency cesarean section was performed and a viable male infant was delivered. Intraoperatively, a placental abruption was identified, and disseminated intravascular coagulation and persistent hypotension developed despite resuscitative efforts. Transesophageal echocardiography revealed normal left ventricular contractility and gross enlargement of the right ventricle and main pulmonary trunk, consistent with acute right ventricular pressure overload and underloading of the left ventricle. Despite resuscitative efforts, the patient died three hours postoperatively. Autopsy showed extensive microvascular plugging of the pulmonary capillaries by fetal cells in all lung fields. This is a rare case of amniotic fluid embolism diagnosed in part and managed pre-mortem with transesophageal echocardiography and confirmed by autopsy findings.
Department of Anesthesiology, Mayo Clinic, Jacksonville, FL 32224, USA. james.christopher@mayo.edu
C F
CF
James
N G
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Feinglass
D M
DM
Menke
S F
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Grinton
T J
TJ
Papadimos
D000328:Adult; D000653:Amniotic Fluid / Q000166:cytology; D001780:Blood Coagulation Tests; D002585:Cesarean Section; D017548:Echocardiography, Transesophageal; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology; D008297:Male; D016343:Monitoring, Intraoperative; D011247:Pregnancy