Survival from Amniotic Fluid Embolism with Disseminated Intravascular Coagulation and Multiple Organ Dysfunction Syndrome: A Case Report |Chapter 5 | Medical Science: Recent Advances and Applications Vol. 9

 

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

Examining the Perinatal Results in Patients Suffering from Acute Fatty Liver of Pregnancy | Chapter 1 | Achievements and Challenges of Medicine and Medical Science Vol. 13

Introduction: Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency requiring immediate attention and intensive care to avoid adverse outcomes for the mother and fetus. High morbidity and mortality are seen among women with AFLP. As this condition poses many complications and is varied in its clinical presentation, the perinatal outcomes in women diagnosed with AFLP were studied.

Materials and Methods: This was a retrospective study that involved all patients over the past 6 years who presented with AFLP. Clinical signs and other altered biochemical parameters were included.

Results: In the study, 19 women were diagnosed to have AFLP. The mean age of the study population was 25.74±3.7 years. 14 ( 73.68% ) women were below the age of 30 years. A gestational age of more than 37 weeks was seen in 13 ( 68.42% ) women. Ten primigravidae ( 52.63% ) and nine multiparous (47.3%) women were found to present with AFLP. The mean blood loss at the time of delivery for a lower-section cesarian section and vaginal delivery was 787.5±494.07 mL and 280±44.72 mL, respectively. The preferred treatment at the time of admission was transfusion of fresh frozen plasma (FFP) (Mean: 7.00±9 pints), followed by transfusion of platelet (Mean: 2.37±3.515 pints), transfusion of packed red blood cells (Mean: 2.21±3.691 pints) and cryoprecipitate (Mean: 0.0±2 pints). Nine ( 47.37% ) women were delivered through emergency lower segment cesarean section (LSCS) and all 4 (21.05%) pregnant women who succumbed to AFLP underwent an LSCS. Among the newborns, 13 (65%) of them were low birth weight and 2 (10.53%) had fetal distress.

Conclusion: This study showed a higher maternal mortality rate of 21% in comparison to other studies. Health professionals should be sensitized about this condition and the use of the existing scoring system available to help in detecting AFLP at an early stage to reduce maternal mortality and adverse fetal outcomes. Blood loss at the time of delivery makes it imminent to arrange for appropriate treatment and supportive care in the management of the patient, which includes fresh frozen plasma transfusion which was found beneficial in the patients.

 

Author (s) Details

 

Christy Vijay
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.

 

Annamma Thomas
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.

 

Angeline Yvette Mascarenhas
Department of Emergency Medicine, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.

 

Naveen Ramesh
Department of Community Medicine, St. John’s Medical College and Hospital, Bengaluru, Karnataka, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v13/4088

Autoimmune Thrombotic Thrombocytopenic Purpura, Disseminated Intravascular Coagulation, Haemophagocytic Lympho Histiocytosis— (Following Corona Virus Infection), Fragmented Germ Cells {Liberal Global Abortions, Contraception—(Red Riverways, Blood Moon, Weakened Earth’s Magnet)} and Absence of Abstinence | Chapter 9 | Highlights on Medicine and Medical Research Vol. 15

 Background: Autoimmunity has increased significantly, which is concerning, as a result of global contraception, abortion, and fragmenting germ cells; three types of life-threatening manifestations are examined here. Case 1: A 28-year-old afebrile woman, a vegetarian, presented to emergency with impaired responsiveness, deep jaundice, one-day menorrhagia, and she had been taking native treatment with leaves for primary infertility for the previous five years; she had a few ecchymotic patches, investigations revealed severe anaemia, thrombocytopenia, haemolytic jaundice, and a peripheral smear confirmed thrombo  Due to cultural ignorance that teaches only three days abstinence after last menstrual periods, instead of seven days abstinence after last menstrual periods, exposure of germ cells to raw endometrial surface from the 4th to 7th days of menstrual cycle resulted in the cumulative autoimmunity thrombotic thrombocytopenic purpura status for the past five years in her sincere effort to conceive a baby. Case 2: A 24-year-old woman who had undergone puerperal sterilisation presented to emergency with unresponsiveness on the fourth day after her last menstrual periods; her investigations revealed a prolonged prothrombin time, a prolonged activated partial thromboplastin time, and a prolonged activated partial thromboplastin time. [non-evidence-based medical practice], 20 million germ cells are fragmented into chromatid breaks, acentric fragments, and ring chromosomes, which are exposed to partially regenerated endometrial surface on the fourth day after last menstrual periods, due to lack of awareness of abstinence up to seven days, resulting in fatal disseminated intravascular coagulation. Case 3: Fatal haemophagocytic lymphohistiocytosis soaring autoimmunity detected in the victim host of corona virus infection, which was directly correlated with extensive tissue damage produced in the victim host by prior surgical abortions. Conclusion: Cases one and two occurred in the absence of abstinence, with germ cell exposure to a partially healed endometrial surface in the former, resulting in thrombotic thrombocytopenic purpura; in the latter, with fragmented 20 million germ cells [by contraception] exposure to a partially healed endometrial surface, resulting in fatal disseminated intravascular coagulation. In three cases, autoimmune hemophagocytic lympho-histiocytosis resulted from corona virus infection, which was caused by extensive tissue damage from liberal global abortions. The Red Russian riverways are yet another example of global warming caused by unabated blood pollution on a global scale. Permafrost melting Frost crashing into the Diesel tanks, with oil spill reflecting on an abortion-polluted river, turns bright red, similar to a blood moon caused by abortion-polluted air. Numerous human lives, with their iron of blood flowing within blood vessels, repelling the earth's magnet, are required to strengthen the earth's magnet. The Arctic ozone hole was closed in May, and environmental pollution was reduced as a result of the absence of global abortions, contraception, and their ozone-depleting blood pollution as a result of the corona virus pandemic's lockdown.

Author (S) Details

Elizabeth JeyaVardhini Samuel
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

Ramalingam
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

Zumu
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

Aakash
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

Celestine Rajmanohar
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

Darmalingam
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

Sundararajan Veerakesari
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

S. Natarajan
Department of General Medicine, Karpagam Faculty of Medical Sciences and Research Coimbatore, Tamil Nadu, India.

View Book :- https://stm.bookpi.org/HMMR-V15/article/view/1959