Critical Care Obstetrics and Gynecology

Amniotic Fluid Embolism After Intrauterine Fetal Demise

Amniotic fluid embolism is a rare but devastating condition. The underlying pathophysiology involves the entry of foetal antigens into the maternal circulation followed by a complex sequence of reactions and activation of the proinflammatory mediator systems similar to the systemic inflammatory response syndrome. 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 gestation for placental abruption with intrauterine foetal demise. The treatment included prolonged cardiopulmonary resuscitation, emergency obstetrical hysterectomy and re-operation with pelvic-abdominal packing and intra-aortic balloon pump (IABP). The coagulopathy was treated with packed red cells, Platelets, FFP, cryoprecipitate and recombinant factor VIIa transfused and titrated with point-of-care testing using Thromboelastography. The woman’s recovery was remarkable with normal neurological, cognitive and near normal cardio-pulmonary functions. The patient suffered from severe renal impairment and remained on outpatient dialysis treatment. We would like to highlight the importance of a multidisciplinary approach and ongoing briefing and continuous evaluation of patient status in complicated cases of amniotic fluid embolism.

Author(s):

Karl Kristensen

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