Atypical Presentation of Amniotic Fluid Embolism

Bastien, John L.; Graves, Jeffrey R.; Bailey, Steven L.

doi:10.1097/00000539-199807000-00027

Cited by 18 publications

(13 citation statements)

References 13 publications

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“…Fatal AFE is most commonly associated with relatively small tears in the uterus, cervix or vagina which have not totally disrupted the wall [11]. The histological visualisation of amniotic fluid debris in the uterine veins was only seldom successful [22][23][24] although it is obvious that amniotic fluid can gain entry into the maternal circulation only via uterine veins. In our study, the components of AF, decidual cells, as well as whole chorionic villi, were only detected in the uterine veins and in the pulmonary circulation in a woman with traumatic uterine rupture and placental separation [24,25].…”

Section: Discussionmentioning

confidence: 99%

Forensic aspects of post-mortem histological detection of amniotic fluid embolism

et al. 2009

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Amniotic fluid embolism (AFE) continues to be one of the most feared and devastating complications of pregnancy. A reliable diagnosis can be made only upon histological examination. A detection of AFE every now and then has a relevant implication on medico-legal aspects of intrapartum or post-partum maternal death. However, there are only isolated reports in the literature concerning the detection interval of amniotic fluid elements after their transfer into the lungs. The objective of this study was to determine how long after the onset of clinical symptoms the elements of amniotic fluid may be detectable in the pulmonary circulation. An autopsy, as well as a histological and toxicological examination of 29 women, who died intrapartum or post-partum were performed. AFE was diagnosed in seven women (25%). The maximum survival time of the women with AFE and also the detection interval of AF in the pulmonary vasculature was 36 h. In the lungs of the women who did not die of AFE, amniotic fluid components were not found. Thus, there is no evidence for a physiologic occurrence of AFE. In women who die some days or even weeks after delivery as a consequence of a haemorrhagic shock following post-partum genital bleeding ensuing from uterine atony, AFE should be considered as a cause of a coagulopathy.

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Section: Discussionmentioning

confidence: 99%

Forensic aspects of post-mortem histological detection of amniotic fluid embolism

et al. 2009

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“…This is the first case report of which we are aware in which nitric oxide has been used in the management of AFE, although its potential therapeutic value has been suggested. 5 In 1999 Tanus-Santos and Moreno, 5 in correspondence about a case report of AFE, 6 suggested that nitric oxide, as a selective pulmonary vasodilator, may offer benefit. They had shown favourable results in animal models of acute severe pulmonary vasoconstriction, 18 and described the use of nitric oxide to manage other pulmonary embolic phenomena.…”

Section: Discussionmentioning

confidence: 99%

“…4 It has been postulated that nitric oxide has potential therapeutic benefit if the patient survives the initial insult, but its use has not been previously described in this setting. [5][6][7] We report the successful use of nitric oxide guided by transoesophageal echocardiography in a parturient with AFE.…”

Section: Introductionmentioning

confidence: 99%

Rapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism

McDonnell

Chan

Frengley

2007

International Journal of Obstetric Anesthesia

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“…Recent studies confirmed the association of AFE and DIC. [6][7][8][9] The pathophysiology of this coagulopathic disorder remains controversial. As discussed in the review on AFE by Davies et al, the experimental data suggest that amniotic fluid has a direct factor X activating property and thromboplastin-like effect.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to haemodynamic collapse and pulmonary injury, 40% of patients surviving the initial haemodynamic insult may develop a disorder of coagulation ranging from minor disturbances in platelet count to disseminated intravascular coagulation (DIC). [3][4][5][6][7][8][9][10] Because initial characteristic signs may be mistaken and therefore make diagnosis difficult, a high index of suspicion for this condition is required as early management is the key point for a favourable outcome. We report on a non-fatal case of AFE occurring during a caesarean section with coagulopathy.…”

Section: Introductionmentioning

confidence: 99%