However non-classical presentations may also occur and the clinician must always consider the possibility of AFE when dealing with an unwell obstetric patient.Īlthough AFE was first identified as a clinical entity in 1941 it remains an unpredictable condition and treatment is still largely supportive. AFE classically presents as a sudden cardiovascular collapse associated with respiratory compromise, fetal distress and the development of a coagulopathy. It most commonly presents in the intra-partum or immediate post-partum period. INTRODUCTIONĪmniotic Fluid Embolism (AFE) is a rare but potentially fatal syndrome that is unique to pregnancy. The neonate suffered from meconium aspiration syndrome but both the mother and baby survived with no long term medical issues. She was extubated on the second ICU day and discharged from ICU on the fourth day. After treatment measures were instituted for the pulmonary hypertension she made a rapid recovery. Echocardiography revealed severe right ventricular failure with elevated pulmonary artery pressures. The mother deteriorated further in the ICU, requiring large doses of vasopressor and inotropic therapy in addition to further blood products to correct her coagulopathy. Amniotic fluid is normally present in the maternal circulation.Amniotic fluid embolism is one of the main causes of direct maternal mortality in the developed world.A diagnosis of amniotic fluid embolism can be made on the basis of laboratory testing.Treatment of amniotic fluid embolism is largely supportive.Amniotic fluid embolism is almost universally associated with the death of the mother and her baby.Which of the following statements relating to amniotic fluid embolism are correct? This is treated with blood and blood product administration and transfer is arranged to the Intensive Care Unit (ICU).ģ. It becomes apparent that a coagulopathy has rapidly developed and approximately one hour after the arrest her coagulation studies reveal an INR of 1.7, APTT 78s, fibrinogen 0.9 g/L, platelets 169 x 10 9/L and a Hb of 12.2 g/dL. Her oxygen requirements increase and high doses of noradrenaline are required to support her circulation. A live male infant is delivered.Īfter delivery the mother’s haemodynamic and respiratory status deteriorates. A caesarean is performed under general anaesthesia. Clinically her cardiac output has normalised, so a decision is made to deliver her baby emergently in theatre. Post arrest the fetus is compromised with a heart rate of 60 bpm. Which of the following are potential causes of collapse and/or cardiac arrest in the pregnant woman? (True or False) On talking to the midwife you discover that the patient initially complained of difficulty breathing and then appeared to lose consciousness and have a seizure.Ģ. This is soon followed by return of spontaneous respiratory effort and some purposeful movement in the upper limbs. Causes specific to pregnancy are likely to be responsibleĪpproximately 2 minutes later a palpable pulse is restored corresponding with a sinus tachycardia on the defibrillation monitor.Transfer to the nearest operating theatre for a peri-mortem caesarean delivery if there is no response to CPR after 4 minutes.Remove fetal monitoring devices prior to defibrillation.Secure the airway early because of a higher risk of aspiration.Apply lateral tilt or manual uterine displacement if over 20 weeks gestation.Which of the following are key differences in the resuscitation of pregnant women? (True or False) The defibrillation pads are just being applied.ġ. She is not making any respiratory effort and no pulse is detectable. On arrival you find the response team performing CPR on a 35 year old parturient (G 2P 0) of 41 weeks and 6 days gestation who presented in spontaneous labour earlier in the day. The answers can be found at the end of the article.Īs the anaesthetist covering the delivery suite you are called to attend urgently because a patient has just collapsed. This scenario is based on an actual case report of an amniotic fluid embolism. Before reading this tutorial, try to answer the questions found within the following scenario.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |