Amniotic fluid embolism (AFE) is a rare obstetrical event
with the highest fatality rate. The exact pathogenesis remains unclear. AFE is
a complex disorder classically characterised by the abrupt onset of hypoxia,
hypotension and consumptive coagulopathy. This chapter presents a case of a
27-year-old patient who suffered from the deadliest combination of obstetrical
nightmare of amniotic fluid embolism, disseminated intravascular coagulation
(DIC) and sepsis and yet recovered completely with neurologically intact. The
patient underwent an emergency caesarean delivery because of sudden
cardiovascular collapse. She had a sudden onset of increased intensity of
labour pains associated with rupture of membranes, backache, and cough with
audible wheeze. Intraoperatively, she had DIC and was hemodynamically unstable.
Surgery was completed with the support of inotropes and vasopressors. The
patient stayed in the ICU for 14 days. She was managed with massive transfusion
protocol (A total of 42 units of blood and blood products were transfused). In
the subsequent postoperative period, she had sepsis with multiple organ
dysfunction syndrome (MODS). The diagnosis of AFE was made after other
differential diagnoses had been ruled out. The successful outcome in this case
is attributable to early recognition with immediate delivery of the fetus,
high-grade resuscitation, timely hysterectomy and aggressive treatment of
coagulopathy by blood and blood products, involvement of a multidisciplinary
team, constant supervision by nursing staff with a positive approach. In
conclusion, AFE remains a diagnosis of exclusion; therefore, a collaborative
multidisciplinary approach is essential for effective management and a
favorable outcome.
Author(s) Details
Anish Kumar Vishal
Department of Obstetrics and Gynaecology, Military Hospital Kirkee, Pune,
Maharashtra, India.
Mohit Agarwal
Department of Obstetrics and Gynaecology, Military Hospital Kirkee, Pune,
Maharashtra, India.
Arunabha Saha
Department of Obstetrics and Gynaecology, Military Hospital Kirkee, Pune,
Maharashtra, India.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v9/6052
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