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

Abstract

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

Is There a Relationship between Hyperkalemia and Propofol?

“…Amniotic fluid embolism could occur during dilatation and curettage. But as described in the case reported by Ray et al11), blood potassium level did not rise typically and usually recovered after CPR. In addition, typical features of disseminated intravascular coagulation (DIC) including thrombocytopenia weren't seen in this patient.…”

Amniotic Fluid Embolism: A Nightmare

“…Other cases have been associated with abdominal trauma, cervical suture removal, ruptured uterus or intrapartum amnioinfusion. 10,11,12 The sudden occurance of severe chills, shivering, sweating and coughing followed by respiratory distress, evidenced by cyanosis,tachypnea and bronchospasm, raises the suspicion of AFE. These symptoms turn into pulmonary edema and cardiovascular collapse and convulsions 10 .…”

Amniotic fluid embolism

“…Amniotic fluid embolism typically occurs during labor and delivery[17] or in the immediate postpartum period,[17] after caesarean delivery,[17] amniocentesis,[17] removal of placenta,[18] or with therapeutic abortion. [18] Other cases have been associated with abdominal trauma,[19] cervical suture removal,[20] ruptured uterus or intrapartum amnioinfusion.…”

“…[18] Other cases have been associated with abdominal trauma,[19] cervical suture removal,[20] ruptured uterus or intrapartum amnioinfusion. [20]…”