In this article, based on current data, a literature review of this rare obstetric complication is attempted, particularly with regard to diagnosis and the basic treatment principles, the timely and correct application of which can provide the best possible outcome for the mother and the newborn.Īmniotic fluid embolism (AFE) is a rare but potentially fatal condition of pregnancy. The treatment is supportive and focuses on rapid stabilization of the cardiopulmonary system, adequate oxygenation of the vital organs and correction of coagulation, ensuring the best possible perinatal outcome. The disease manifests abruptly with cardiovascular shock, encephalopathy, fetal discomfort and disseminated intravascular coagulation. Amniotic fluid embolism is believed to happen due to an anaphylactic reaction to embryonic antigens that enter the mother's circulation and trigger a variety of immune processes that produce an anaphylactic-like response. The pathogenetic mechanism has not been fully elucidated to date. The 2 separate areas of infarction, corresponding to the 2 different coronary territories, suggest an AFE-related thrombotic/thromboembolic etiology.Īmniotic fluid embolism is a rare, unpredictable and often catastrophic obstetric complication that usually occurs during labor or caesarean section. This is the first report of a STEMI triggered by an AFE. CONCLUSIONS AFE should be considered in women with acute cardiorespiratory failure during labor.
Referring to the coronary artery anatomy in a computed tomography scan of the chest, the infarcted areas correlated with 2 different coronary supply territories. Cardiac magnetic resonance imaging performed 3 months later demonstrated myocardial scarring in 2 different areas. After the patient's transfer to the Intensive Care Unit, ST-segment elevations resolved and the myocardial infarct was managed medically. Owing to the ongoing DIC, coronary angiography could not be performed. Transesophageal echocardiography revealed hypokinesia to akinesia of the inferior wall. Laboratory results fulfilled the criteria for DIC, and hemostatic resuscitation and mechanical hemostasis were performed. Simultaneously occurring severe vaginal hemorrhage and an ST-elevation myocardial infarction (STEMI) triggered the diagnosis of AFE. Short mechanical resuscitation was performed before spontaneous circulation returned. After medical birth induction, she had a convulsive seizure and cardiorespiratory arrest. CASE REPORT A 30-year-old primigravida and primipara woman with no prior medical history was admitted for labor after intrauterine fetal death at 37 weeks of gestation. Usually, acute pulmonary hypertension results in acute right ventricular failure, while DIC manifests by hemorrhagic and ischemic complications, ultimately leading to multi-organ failure and death. Conclusions: Measuring C1 esterase inhibitor, squamous cell carcinoma antigen, and complements C3 and C4 in postpartum hemorrhage may allow assessment of the extent of anaphylactoid reaction and the requirement for fresh frozen plasma transfusion.īACKGROUND Amniotic fluid embolism (AFE) is an extremely rare, life-threatening complication of labor that leads to hyper-acute induction of inflammation and disseminated intravascular coagulation (DIC). The fresh frozen plasma transfusion volume was higher in patients with low C1 esterase inhibitor and high squamous cell carcinoma antigen in the interaction analysis. C3 had the highest area under the curve (0.843) and cut-off value (80 mg/dL) for the prediction of fresh frozen plasma transfusion of ≥15 units. In multivariate analysis, only C3 was an independent factor associated with fresh frozen plasma transfusion volume (regression coefficient: –0.173, p = 0.022).
In univariate analysis, C1 esterase inhibitor (correlation coefficient: –0.368, p < 0.001), C3 (correlation coefficient: –0.376, p < 0.001) and C4 (correlation coefficient: –0.291, p < 0.001) were negatively correlated with fresh frozen plasma transfusion volume. Results: The analysis included 132 patients with postpartum hemorrhage. The interaction of low C1 esterase inhibitor and squamous cell carcinoma antigen with respect to the fresh frozen plasma transfusion volume was analyzed. We analyzed the relationship between the fresh frozen plasma transfusion volume and the above-mentioned biomarkers. Methods: In this single-centered prospective observational study, consecutive patients with postpartum hemorrhage were evaluated for C1 esterase inhibitor, squamous cell carcinoma antigen, C3 and C4.
Background: We aimed to evaluate the utility of C1 esterase inhibitor, squamous cell carcinoma antigen, and complements C3 and C4 in the prediction of fresh frozen plasma transfusion requirements in postpartum hemorrhage and characterize the involvement of amniotic fluid embolism in the pathophysiology of postpartum hemorrhage.
0 kommentar(er)
