title: Algorithm-based coagulation management of catastrophic amniotic fluid embolism.
abstract: Amniotic fluid embolism (AFE) is a rare, but often catastrophic, complication of pregnancy and associated with severe coagulopathy. We present an algorithm-based approach in managing coagulopathy and hemorrhage in a fatal case of histopathologically proven AFE. Thrombelastometry was used for rapid evaluation of the coagulation status. Stop of extensive hyperfibrinolysis with tranexamic acid, stabilization of initial clot formation with high-dose fibrinogen and platelet transfusions, and use of prothrombin complex concentrate together with a 1: 1 transfusion regimen of red packed cells and fresh frozen plasma was successful to control diffuse bleeding and restore clot firmness after hysterectomy. Stable clotting situation was maintained despite further clinical deterioration and development of multiple organ failure in this patient.
authors.affiliation: Clinic of Anesthesiology, Ludwig-Maximilians-University Munich, Munich, Germany. thorsten.annecke@med.uni-muenchen.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Annecke
authors.forename: Thomas
authors.initials: T
authors.lastname: Geisenberger
authors.forename: Rainer
authors.initials: R
authors.lastname: Kürzl
authors.forename: Randolph
authors.initials: R
authors.lastname: Penning
authors.forename: Bernhard
authors.initials: B
authors.lastname: Heindl
mesh_terms: D000138:Acidosis / Q000209:etiology; D000328:Adult; D000465:Algorithms; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D016913:Blood Component Transfusion; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019090:Case Management; D002388:Catastrophic Illness; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004619:Embolism, Amniotic Fluid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017809:Fatal Outcome; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007044:Hysterectomy; D007231:Infant, Newborn; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D018457:Placenta, Retained / Q000175:diagnosis; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D001779:Blood Coagulation Factors; D002317:Cardiovascular Agents; C025667:prothrombin complex concentrates; D014148:Tranexamic Acid; D005340:Fibrinogen