Amniotic Fluid Embolism: Early Findings of Transesophageal Echocardiography

Shechtman, Moshe; Ziser, Avishai; Markovits, Robert; Rozenberg, B.

doi:10.1097/00000539-199912000-00025

Cited by 35 publications

(40 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10 Shechtman suggests that transesophageal echocardgiograhy (TEE), used early in the insult, may help in establishing the diagnosis of the associated heart failure and may guide the therapy of this catastrophic condition. 11 However, intraoperative TEE was not available at our institution, nor was it necessary in this case. Other investigators have looked at various markers that could rapidly detect and aid in the diagnosis of AFE.…”

Section: Conclusion : On Sait Maintenant Que Les Caractéristiques Phmentioning

confidence: 91%

Embolie amniotique lors d’une interruption de grossesse au deuxième trimestre : exposé d’un cas

Ray

Vallejo

Creinin

et al. 2004

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event.C Co on nc cl lu us si io on ns s: : It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors. MNIOTIC fluid embolism (AFE) is a rare life-threatening complication unique to pregnancy. AFE has a mortality rate of 61 to 86% and accounts for approximately 10% of all maternal deaths in the United States. 1,2 AFE has a variable presentation, ranging from mild degrees of organ dysfunction to cardiovascular collapse, coagulopathy and death. 1,2 AFE usually presents at term during labour. 3 In this report, we present a patient in her second trimester of pregnancy who developed sudden hypoxic respiratory failure followed by cardiopulmonary arrest and coagulopathy following dilatation and evacuation (D & E) for intra-uterine fetal demise. Objectif

show abstract

Section: Conclusion : On Sait Maintenant Que Les Caractéristiques Phmentioning

confidence: 91%

Embolie amniotique lors d’une interruption de grossesse au deuxième trimestre : exposé d’un cas

Ray

Vallejo

Creinin

et al. 2004

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…The few available reports of transesophageal echocardiography, performed shortly after embolization, universally describe a marked right ventricular failure. [5][6][7] This response appears to be caused not only by the pulmonary embolism but also by vasoconstriction produced by vasoactive substances released when amniotic fluid enters the pulmonary circulation. [8][9][10] Interplay among left ventricular dysfunction, acute lung injury, and activation of clotting factors is suspected.…”

Section: Commentmentioning

confidence: 99%

Amniotic Fluid Embolism Complicated by Paradoxical Embolism and Disseminated Intravascular Coagulation

Kumar

Wong

Maysky

et al. 2010

American Journal of Critical Care

View full text Add to dashboard Cite

Amniotic fluid embolism is a rare syndrome with potentially lethal outcomes. Complications include cardiorespiratory failure, disseminated intravascular coagulation, seizures, neurological deficits, and death. A 34-year-old woman had amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation. Emergency cesarean section followed by cardiopulmonary bypass with removal of the clot from the atria and closure of the patent foramen ovale was performed, resulting in a good outcome for both the mother and the baby. Subsequent treatment with anticoagulants for 6 months was recommended. A literature review revealed that this clinical scenario is rare but can be successfully managed by cardiopulmonary bypass and thromboembolectomy. Data on guidelines for the use of anticoagulation in this situation are limited.

show abstract

“…For instance, transesophageal echocardiography was effectively applied to diagnose the causes of pulmonary obstruction (catastrophic pulmonary vasoconstriction vs intracardiac or pulmonary artery embolus [2][3][4]) and establish the diagnosis of paradoxical AFE [5,6] (identification of intracardiac shunts between venous and atrial circulation in the form of a patent foramen ovale or ventricular septal defect, and identification of intracardiac thrombi). Cardiopulmonary bypass [3] or cardiopulmonary bypass surgery [6,7] succeeded to rescue AFE patients who had failed to respond to standard treatment; early application of extracorporeal membrane oxygenation rescued the patient who was unresponsive to standard oxygen therapy [8], and with inhaled nitric oxide prompt reversal of critical hemodynamic compromise was obtained [ 9].…”

Section: Introductionmentioning

confidence: 99%

Heparin and other anticoagulants in amniotic fluid embolism (AFE): Literature review and concept of the therapy

Uszyński¹,

Uszyński²

2013

OJOG

View full text Add to dashboard Cite

Aim: The objective of this study is to review all the reported outcomes of heparin application in amniotic fluid embolism (AFE) so far and to find out why, when and how heparin or other anticoagulants should be used in AFE. Material and methods: We searched Medline (from 1969 to 2011), using two key words: 1) amniotic fluid embolism; 2) amniotic fluid embolism and heparin. The search for the former produced 1127 replies, of which 208 were case reports of AFE. In response to the other key word, there were 94 articles. We looked through all the articles, selecting those relevant for our study. Results: In the years 1969-2011, 208 AFE cases were reported. Heparin (unfractionated heparin) or low molecular weight heparin (LMWH) was applied in 20 cases (9.6%), being the main drug in 11 cases (5.3%) and in 6 cases as a component of spectacular treatment of AFE (surgical treatment and extracorporal membrane oxygenation). In one of these cases anithrombin (AT) with LMWH was used. In one patient heparin therapy was considered to be unsuccessful and hence recombinant plasminogen activator (rt-PA) was instituted. All the patients survived. Conclusions: 1) The attempts to use heparin in AFE could be defined as promising, although the number of treated patients is too small for conclusion; 2) The postulate to use heparin at the very onset of AFE (a bolus of 10,000 U followed by monitored intravenous infusion) has serious justification: one of the pathways of AFE is the target for heparin (coagulation pathway).

show abstract

Amniotic Fluid Embolism: Early Findings of Transesophageal Echocardiography

Cited by 35 publications

References 4 publications

Embolie amniotique lors d’une interruption de grossesse au deuxième trimestre : exposé d’un cas

Embolie amniotique lors d’une interruption de grossesse au deuxième trimestre : exposé d’un cas

Amniotic Fluid Embolism Complicated by Paradoxical Embolism and Disseminated Intravascular Coagulation

Heparin and other anticoagulants in amniotic fluid embolism (AFE): Literature review and concept of the therapy

Contact Info

Product

Resources

About