Initial management of acute circulatory failure in amniotic fluid embolism: A narrative review

Trieu, Ngan Hoang Kim; Pham, Huy Minh; Mai, Anh Tuan

doi:10.1016/j.tacc.2023.101288

Cited by 2 publications

(5 citation statements)

References 80 publications

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“…Diagnosis of AFE would be facilitated by the identification of an unequivocal biomarker for the disease. Although several potential biomarkers have been investigated, no gold-standard diagnostic test is available to date [7]. While tryptase was not detected in the maternal serum, the levels of IGFBP-1 were elevated further supporting a diagnosis of AFE [17].…”

Section: Discussionmentioning

confidence: 96%

“…Unlike typical cases of AFE, sudden cardiorespiratory collapse did not occur [7]. Therefore, cardiopulmonary resuscitation and/or extracorporeal membrane oxygenation was not required.…”

Section: Discussionmentioning

confidence: 96%

“…By the Clark diagnostic criteria for AFE, coagulopathy was detected before the loss of sufficient blood to account for dilutional or shock-related consumptive coagulopathy [6]. Mechanistically, it is proposed that the maternal systemic inflammatory response observed in AFE activates the coagulation extrinsic pathway and results in the consumption of coagulation factors [7].…”

Section: Discussionmentioning

confidence: 99%

“…Disseminated intravascular coagulation occurs in 83% of AFE cases and must be promptly corrected by blood transfusion [7]. Recently, de Lloyd et al studied a large cohort of women with PPH and identified an uncommon severe coagulopathy profile named AOC [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…Older maternal age, placenta previa, placental abruption, cesarean section, and instrumental vaginal delivery have been identified as risk factors [4]. Recommendations for the initial care of AFE comprise cardiopulmonary resuscitation, massive transfusion protocol (to control bleeding and correct coagulopathy), and management of pulmonary hypertension and right ventricular failure [2,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Amniotic Fluid Embolism Coagulopathy Guided by the Point-of-Care Quantra QStat® Hemostasis System: A Case Report

Fradin,

Belin,

Bonnet

et al. 2024

Cureus

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Amniotic fluid embolism (AFE) is a rare pregnancy complication associated with high maternal mortality that occurs during labor or in the early postpartum period. The diagnosis of AFE is challenging because signs and symptoms are common to other obstetric complications. Early identification and management of profound coagulopathy associated with AFE is essential to improve patient survival. We present a case of a 31-year-old woman with placenta previa and clinical suspicion of AFE after cesarean section. Immediately after delivery, the parturient presented hypotension, hypoxia, coagulopathy, and severe postpartum hemorrhage. We hereby discuss the role of the most recently developed point-of-care viscoelastic testing device, the Quantra QStat ® system (Stago Group Company; HemoSonics LLC, Durham, NC), for early detection of acute obstetric coagulopathy and guided hemostatic treatment.

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Section: Discussionmentioning

confidence: 96%

“…Unlike typical cases of AFE, sudden cardiorespiratory collapse did not occur [7]. Therefore, cardiopulmonary resuscitation and/or extracorporeal membrane oxygenation was not required.…”

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Amniotic Fluid Embolism Coagulopathy Guided by the Point-of-Care Quantra QStat® Hemostasis System: A Case Report

Fradin,

Belin,

Bonnet

et al. 2024

Cureus

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Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Systematic Review of Case Reports

Trieu,

Nguyen,

Pham

et al. 2024

ASAIO Journal

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Amniotic fluid embolism (AFE) is an obstetric complication that can result in acute circulatory failure during and after labor. The effectiveness of extracorporeal membrane oxygenation (ECMO) in AFE patients has not been established, especially in the context of coagulopathy. This review aims to evaluate the efficacy of ECMO support in AFE patients. We conducted a systematic review of case reports following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was performed using a standardized tool. Out of 141 studies screened, 33 studies included 79 AFE patients. The median age was 34 years, and the median gestational age was 37.5 weeks. The majority of AFE cases occurred during cesarean section delivery (55.2%), followed by labor before fetal delivery (26.7%). Extracorporeal membrane oxygenation configurations included venoarterial ECMO (81.3%) and extracorporeal cardiopulmonary resuscitation (CPR, 10.7%). The maternal survival rate was 72%, with 21.2% experiencing minor neurological sequelae and 5.8% having major neurological sequelae. Rescue ECMO to support circulation has demonstrated both safety and efficacy in managing AFE. We suggest early activation of local or mobile ECMO as soon as an AFE diagnosis is established. Further studies are needed to assess the benefits and implications of early ECMO support in AFE patients.

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Initial management of acute circulatory failure in amniotic fluid embolism: A narrative review

Cited by 2 publications

References 80 publications

Amniotic Fluid Embolism Coagulopathy Guided by the Point-of-Care Quantra QStat® Hemostasis System: A Case Report

Amniotic Fluid Embolism Coagulopathy Guided by the Point-of-Care Quantra QStat® Hemostasis System: A Case Report

Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Systematic Review of Case Reports

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