title: Paradoxical amniotic fluid embolism presenting before caesarean section in a woman with an atrial septal defect.
abstract: We present a case of presumed amniotic fluid embolism in a 33-year-old parturient at 30 weeks of gestation, which occurred just before she was due to receive spinal anaesthesia for urgent caesarean section. While sitting, the woman suddenly lost consciousness, started having convulsions and finally suffered cardiorespiratory collapse. She was resuscitated and a live baby was delivered by emergency caesarean section. An echocardiogram performed postoperatively showed a large atrial septal defect and severe right ventricular dysfunction with moderate pulmonary hypertension. Paradoxical amniotic fluid embolism was diagnosed. After extubation she was aphasic and had a right hemiparesis. She made a good recovery and was discharged from hospital 24 days later, at which time she had a slight weakness on her right side. Three months later she had a normal gait with no obvious neurological deficit.
authors.affiliation: Department of Anaesthesia and Intensive Care, Indraprastha Apollo Hospitals, New Delhi, India. kumarvk42@hotmail.com
authors.forename: V
authors.initials: V
authors.lastname: Kumar
authors.forename: M
authors.initials: M
authors.lastname: Khatwani
authors.forename: S
authors.initials: S
authors.lastname: Aneja
authors.forename: K K
authors.initials: KK
authors.lastname: Kapur
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D004562:Electrocardiography; D004619:Embolism, Amniotic Fluid / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008279:Magnetic Resonance Imaging; D010291:Paresis / Q000209:etiology; D011247:Pregnancy; D020127:Recovery of Function; D014463:Ultrasonography