Rapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism.
We describe a case of amniotic fluid embolism presenting as cardiovascular collapse during labour. After initial resuscitation and emergency caesarean section, the patient was transferred to the intensive care unit with profound hypoxaemia, a high inotropic drug requirement and severe coagulopathy. A transoesophageal echocardiogram demonstrated acute right ventricular overload, severe pulmonary artery hypertension and marked diastolic dysfunction of the left ventricle secondary to a dilated right ventricle. The introduction of nitric oxide at 40 ppm produced a dramatic improvement in her cardiorespiratory status. Mother and baby both survived with no apparent long term sequelae.
McDonnell
N J
NJ
Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand. nolanvini@mac.com
Chan
B O
BO
Frengley
R W
RW
D000328:Adult; D015360:Analgesia, Epidural; D000768:Anesthesia, General; D001034:Apgar Score; D001780:Blood Coagulation Tests; D017548:Echocardiography, Transesophageal; D004619:Embolism, Amniotic Fluid / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy / Q000209:etiology; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use*; D011247:Pregnancy; D012769:Shock / Q000188:drug therapy* / Q000209:etiology*
D009569:Nitric Oxide