Amniotic fluid embolism after intrauterine fetal demise.
We present a case of the successful treatment of severe amniotic fluid embolism in a 41-year-old woman undergoing emergency caesarean section at 36 weeks of gestation for placental abruption and intrauterine fetal demise. The treatment included prolonged cardiopulmonary resuscitation, emergency hysterectomy, re-operation with intra-abdominal packing and intra-aortic balloon pump insertion. The patient made a remarkable recovery and to date has minimal residual morbidity. Amniotic fluid embolism syndrome (AFES) is a rare and often fatal obstetric condition that remains one of the main causes of maternal mortality in developed countries. The incidence varies from 2 to 6 per 100,000 and suggested mortality rates exceed 60%.1-2 The classic triad of sudden hypoxia, hypotension and coagulopathy with acute onset during labour or immediately after delivery forms the hallmark of the AFES diagnosis, however AFES is primarily a clinical diagnosis of exclusion. We present a case of successful maternal outcome following severe amniotic fluid embolism after placental abruption and intrauterine fetal demise.
Obstetrics and Gynaecology Consultant, Wellington Hospital CCDHB.
Karl
K
Kristensen
Obstetrics and Gynaecology Consultant, Senior Lecturer, Wellington Hospital CCDHB and Otago University.
Fali
F
Langdana
Obstetrics and Gynaecology Consultant, Wellington Hospital CCDHB.
Howard
H
Clentworth
Obstetrics and Gynaecology Registrar, Wellington Hospital CCDHB.
Chu
C
Hansby
Anaesthetics Consultant, Wellington Hospital CCDHB.
Paul
P
Dalley
D000037:Abruptio Placentae / Q000175:diagnosis*; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D002585:Cesarean Section; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005313:Fetal Death; D006801:Humans; D007044:Hysterectomy; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*