Clinical course of disseminated intravascular coagulopathy‐type amniotic fluid embolism: A report of three cases

Hasegawa, Akihiro; Murakoshi, Takeshi; Otsuki, Yoshiro; Torii, Y.

doi:10.1111/jog.13142

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Typical symptoms and signs of AFE include rapid deterioration of maternal condition, sudden onset of cardiac arrest or hypotension, dyspnea, and cyanosis. However, consumption coagulopathy without cardiopulmonary arrest was recently proposed as an incomplete form of AFE [15]. Intriguingly, in our study, there were 2 cases (case number 4 and 8) that manifested symptoms of clinical coagulopathy and neurologic signs without cardiorespiratory compromise.…”

Section: Discussionmentioning

confidence: 46%

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

et al. 2021

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Objective This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Methods This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. Results The median maternal age was 33 years (range, 28-40 years). Regarding symptoms, cardiovascular arrest, hypotension, respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%, and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability, showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7% of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutes after delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfying all 4 criteria and cases with at least 1 missing criterion. Conclusion Two-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates of maternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy between the clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.

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Section: Discussionmentioning

confidence: 46%

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

et al. 2021

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“…However, during the cesarean delivery in the present case, fibrinogen level suddenly decreased to 59 mg/dL, which was much lower than that needed to diagnose overt DIC (≤150 mg/dL) . We believe this was because the ruptured dilated veins due to the myometrial sectioning were exposed to amniotic fluid, resulting in a DIC type of amniotic fluid embolism, although there were no severe cardiopulmonary symptoms involved in this case. Previous studies indicated that fibrinogen levels <87 mg/dL were associated with a very high rate (95.2%) of DIC requiring massive transfusions .…”

Section: Discussionmentioning

confidence: 49%

Rupture of hidden abnormal myometrial vessels during cesarean delivery of a patient with subserosal leiomyoma: A possible pathogenesis of sudden‐onset disseminated intravascular coagulation

Ushijima

Wang

et al. 2018

Clinical Case Reports

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“…There are small numbers of women who present with significant and unexpected hypofibrinogenemia early during the PPH without maternal collapse or other apparent causes of coagulopathy. 61 The etiology of the bleed may be ascribed to other obstetric causes of PPH or obstetric coagulopathy of unknown cause but they may represent part of the AFE spectrum where prompt recognition and treatment is essential. 61…”

Section: Incidence Of Coagulation Abnormalities In Pphmentioning

confidence: 99%

“…61 The etiology of the bleed may be ascribed to other obstetric causes of PPH or obstetric coagulopathy of unknown cause but they may represent part of the AFE spectrum where prompt recognition and treatment is essential. 61…”

Section: Incidence Of Coagulation Abnormalities In Pphmentioning

confidence: 99%

“…60 It is proposed that the coagulation impairment is initially driven by massive fibrinogen consumption, reduced fibrinogen function and breakdown of cross-linked fibrin, elevation of D dimers, and reduced factor V levels. [61][62][63] Early hypofibrinogenemia drives severe PPH once cardiac output is restored after the initial collapse, Thromboelastography for Management of Postpartum Hemorrhage Collis, Bell 153 leading to further hypofibrinogenemia, then thrombocytopenia and clotting factor deficiency. Early hyperfibrinolysis appears to be a key feature and early use of tranexamic acid is essential.…”

Section: Amniotic Fluid Embolusmentioning

confidence: 99%

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The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

Collis

Bell

2022

Semin Thromb Hemost

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Postpartum hemorrhage (PPH) is a common cause of significant maternal morbidity and mortality that can be associated with coagulopathy, especially hypofibrinogenemia. There is interest in point-of-care viscoelastic hemostatic assays (POC-VHA) in PPH because prompt knowledge of coagulation status can aid diagnosis, identify cases of severe coagulopathy, and allow ongoing monitoring during rapid bleeding. The incidence of coagulopathy in most cases of PPH is low because of the procoagulant state of pregnancy, including raised fibrinogen levels of around 4 to 6 g/L. A Clauss fibrinogen of >2 g/L or POC-VHA equivalent has been found to be adequate for hemostasis during PPH. POC-VHA has been used successfully to diagnose hypofibrinogenemia (Clauss fibrinogen of ≤2 g/L) and guide fibrinogen treatment which has reduced bleed size and complications of massive transfusion. There are uncertainties about the use of POC-VHA to direct fresh frozen plasma and platelet administration during PPH. Several POC-VHA algorithms have been used successfully incorporated in the management of many thousands of PPHs and clinicians report that they are easy to use, interpret, and aid decision making. Due to the relative cost of POC-VHA and lack of definitive data on improving outcomes, these devices have not been universally adopted during PPH.

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Clinical course of disseminated intravascular coagulopathy‐type amniotic fluid embolism: A report of three cases

Cited by 8 publications

References 13 publications

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

Rupture of hidden abnormal myometrial vessels during cesarean delivery of a patient with subserosal leiomyoma: A possible pathogenesis of sudden‐onset disseminated intravascular coagulation

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

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