Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis

Abstract

Background Amniotic fluid embolism (AFE) is a rare, life threatening obstetric complication, often associated with severe coagulopathy. Induced abortions are extremely safe procedures however complications including AFE can occur. Case presentation A 29-year-old previously healthy woman, gravida 1 para 0, presented for a scheduled second trimester induced abortion via dilation and evacuation at 22-weeks gestation. The case was complicated by a suspected AFE with associated profound coagulopathy. Viscoelastic point-of-care coagulation analysis was used to successfully and swiftly guide management of her coagulopathy. Conclusion AFE can occur in the setting of induced abortion. This case report suggests viscoelastic point-of-care coagulation analyzers may aid in the management of pregnancy-related coagulopathy by providing faster coagulation assessment than laboratory testing, and facilitating timely, targeted management of coagulopathy.

Sudden onset of syncope and disseminated intravascular coagulation at 14 weeks of pregnancy: a case report

“…These materials provoked cerebral vasospasm and affected the coagulation system through an anaphylactoid reaction, resulting in sudden-onset syncope and DIC. It is possible for AFE to occur without labor, for instance, following medical and surgical abortion [6][7][8], spontaneous miscarriage [9], or obstetric procedures including diagnostic amniocentesis [10] and amnioinfusion [11]. The absence of apparent cardiorespiratory collapse in our patient indicates that DIC-type AFE may have occurred rather than conventional AFE.…”

“…Reportedly, 70% of AFE/ASP occurs during vaginal delivery, 11% after delivery, and 19% during cesarean delivery [ 2 ]. There are reports of AFE/ASP occurring in the second trimester during induced abortion [ 6 , 7 ]. These events rarely occur in the absence of labor, but there are reports of AFE/ASP occurring during medical or surgical abortion [ 6 – 8 ], spontaneous miscarriage [ 9 ], or obstetric procedures including amniocentesis [ 10 ] and amnioinfusion [ 11 ].…”

Interpretation of Chinese expert consensus on diagnosis and management of amniotic fluid embolism

“…[ 1 , 5 ] In rare instances based on case reports, AFE can occur following induced abortion, transabdominal amnioinfusion, transabdominal amniocenteses, blunt abdominal trauma, surgical trauma, or removal of a cervical suture. [ 9 – 14 ]…”

Excessive fibrinolysis detected with thromboelastography in a case of amniotic fluid embolism: fibrinolysis may precede coagulopathy

“…Although it is presumed that over 80% of cases of AFE cases are accompanied by coagulopathy 1) , the pathology of disseminated intravascular coagulation (DIC) is not well understood not only because of rarity of AFE but also because of the limited availability of laboratory testing in emergent clinical settings. Recently, point-ofcare viscoelastometric methods, such as thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®), have been used to monitor blood coagulation in obstetrics [2][3][4][5][6] , although sufficient data on serial TEG/ROTEM measurements in normal patients during immediate postpartum period are not established yet. We describe a case of AFE whose characteristic data for coagulation and fibrinolysis were timely depicted with sequential TEG.…”

“…Their observation is quite similar with ours regarding the detection of hyper-fibrinolysis and its prompt resolution after adequate treatment. However, another four reports of AFE assessed blood samples with ROTEM did not detect hyper-fibrinolysis [3][4][5][6] . This discrepancy might be explained by the rather late timing of blood sampling in the latter four reports, because the phase of the disease might progress in extremely rapid fashion.…”