Amniotic fluid embolism during caesarean section

Amniotic Fluid Embolism (AFE): A Review of the Literature Orientated on Two Clinical Presentations—Typical and Atypical

“…In the years 1998-2004, such terms as "atypical presentation of amniotic fluid embolism", "amniotic fluid embolism and isolated disseminated intravascular coagulation", "amniotic fluid embolism with isolated coagulopathy…" and "transient intracardiac thrombi in amniotic fluid embolism" appeared in report headlines. Symptoms described in these reports [17,21,22,[25][26][27], as well as in others [28][29][30][31][32][33][34][35][36][37][38], were the basis for distinguishing four subclasses of atypical AFE (Figure 1). Interestingly, in a few cases of atypical AFE circulating epithelial cells were detected, which was then the crowning evidence for AFE.…”

“…Before cesarean section: -fetal distress (late decelerations, meconium-staind amniotic fluid) -fetal bradycardia followed by mother's disseminated intravascular coagulation (DIC) [19,26,[30][31][32][33][34][35] During cesarean section: -ventricular tachycardia and hypotension -drop in blood pressure disproportional to intraoperative blood loss, cyanosis plus reduced pO 2 and increased pCO 2 -excessive intraoperative bleeding, subperitoneal ecchymoses in the uterine region, intracardiac thrombus in case of paradoxical AFE -obstetric shock, cardiac arrest and consumptive coagulopathy [18,28,[32][33][34][35][36][37] After cesarean section: -uterine bleeding with non-clotting blood and with no clots -liquid blood in the abdominal cavity (reoperation) -liquid blood in postoperative wound (without clots) -wound dressings soaked with blood -laboratory findings: consumption coagulopathy -cardiac arrest and consumption coagulopathy -shock, respiratory distress and coma…”

“…a/AFE is sometimes preceded by prodromal symptoms such as fetal bradycardia (late decelerations) and/or meconium-stained amniotic fluid (fetal distress) followed by mother's symptoms of AFE [17,24,[28][29][30][31][32][33]. This is probably the earliest effect of amniotic fluid invasion into the utero-placental circulation (induction of local DIC and impaired oxygen supply to the fetus); b/During cesarean section, the initial presentation of AFE involves impaired oxygenation with no anesthetic causes and a sudden decrease in blood pressure disproportional to the intraoperative blood loss [30,32]; profuse intraoperative hemorrhage with or without uterine atony has also been noted [26,[30][31][32][33]; intraoperative AFE with cardiac arrest and severe coagulopathy has been also described [16,26]; c/The initial presentation of AFE after cesarean section can be severe coagulopathy with bleeding from all intravenous puncture sites, the vagina and abdominal incisions; the postoperative wound can contain clot-free liquid blood (27,36,38,40, personal communication).…”

Disseminated intravascular coagulation type of amniotic fluid embolism: a challenging case report with favorable outcome

“…The diagnosis of AFE is based primarily on clinical observations related to the specific context of pregnancy. Detection of squamous cells or other debris in the pulmonary arterial bed of women is neither specific nor sensitive for the diagnosis of AFE [ 4 , 7 ]. In fact, fetal debris include different components like immature squamous cells, fetal hair, or mucin...The identification of immature squamous cells is purely morphological.…”

“…Finding fetal squamous cells or other fetal debris in the broncho-alveolar lavage is encountered especially if the patient develop pulmonary oedema. The latter is responsible of an alveolar capillary membrane damage leading to the crossing of the amniotic fluid material from the maternal circulation to the pulmonary alveoli [ 7 ].…”