![]() ![]() Treatment of amniotic fluid embolism is largely supportive.Amniotic fluid embolism is almost universally associated with the death of the mother and her baby.Which of the following statements relating to amniotic fluid embolism are correct? This is treated with blood and blood product administration and transfer is arranged to the Intensive Care Unit (ICU).ģ. It becomes apparent that a coagulopathy has rapidly developed and approximately one hour after the arrest her coagulation studies reveal an INR of 1.7, APTT 78s, fibrinogen 0.9 g/L, platelets 169 x 10 9/L and a Hb of 12.2 g/dL. Her oxygen requirements increase and high doses of noradrenaline are required to support her circulation. A live male infant is delivered.Īfter delivery the mother’s haemodynamic and respiratory status deteriorates. A caesarean is performed under general anaesthesia. Clinically her cardiac output has normalised, so a decision is made to deliver her baby emergently in theatre. Post arrest the fetus is compromised with a heart rate of 60 bpm. ![]() ![]() Which of the following are potential causes of collapse and/or cardiac arrest in the pregnant woman? (True or False) On talking to the midwife you discover that the patient initially complained of difficulty breathing and then appeared to lose consciousness and have a seizure.Ģ. This is soon followed by return of spontaneous respiratory effort and some purposeful movement in the upper limbs. Causes specific to pregnancy are likely to be responsibleĪpproximately 2 minutes later a palpable pulse is restored corresponding with a sinus tachycardia on the defibrillation monitor.Transfer to the nearest operating theatre for a peri-mortem caesarean delivery if there is no response to CPR after 4 minutes.Remove fetal monitoring devices prior to defibrillation.Secure the airway early because of a higher risk of aspiration.Apply lateral tilt or manual uterine displacement if over 20 weeks gestation.Which of the following are key differences in the resuscitation of pregnant women? (True or False) The defibrillation pads are just being applied.ġ. She is not making any respiratory effort and no pulse is detectable. On arrival you find the response team performing CPR on a 35 year old parturient (G 2P 0) of 41 weeks and 6 days gestation who presented in spontaneous labour earlier in the day. The answers can be found at the end of the article.Īs the anaesthetist covering the delivery suite you are called to attend urgently because a patient has just collapsed. This scenario is based on an actual case report of an amniotic fluid embolism. All rights reserved.Before reading this tutorial, try to answer the questions found within the following scenario. In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.īlood product cardiac arrest coagulation cryoprecipitate dobutamine norepinephrine platelet right ventricular failure.Ĭopyright © 2019 Elsevier Inc. Amniotic fluid embolism-related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150-200 mg/dL). Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. If such failure is identified, treatment that is tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible because this is an easy and reliable method of identifying a failing right ventricle. ![]() We describe key features of initial treatment of patients with amniotic fluid embolism. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. ![]()
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