![]() Close follow-up was performed during her hospital stay: the outcome was favorable allowing mother and baby to return home after 11 days. Blood clots were removed, but no active bleeding was identified. Eight hours after the first intervention, she required a second-look surgery due to massive blood exteriorization in drains. She was transferred to the intensive care unit. At the end of surgery, bleeding was controlled, and blood pressure was maintained with noradrenalin at a mean of 70 mmHg. Blood test evolution during management of our patient.ġ200 UI of combined coagulation factors (Prothromplex ®), 11 mg of recombinant factor VIIa, 10 g of tranexamic acid and 12 g of fibrinogen in total. The patient received 13 liters of crystalloids, 17 units of packed red blood cells, 12 units of fresh frozen plasma, 3 platelet units, Given that hemorrhage could not be controlled (3 L blood loss), an emergency hysterectomy was performed. Clinical and biological features pointed to the diagnosis of amniotic fluid embolism, which triggered a specific emergency routine requiring immediate and aggressive intervention via efficient collaborative work between obstetric and anesthetic teams.Īs a result, aggressive blood and coagulation factors transfusion was initiated. Forty minutes after initiation of surgery, blood tests showed anemia (99 g/L), thrombocytopenia (63 G/L) and severely disturbed coagulation (Quick 11, PTT > 160 s, fibrinogen < 0.5 g/L), indicating the presence of DIC ( Table 1). Blood loss was estimated at 3 liters, and clinically abnormal coagulation was noted. The uterus remained atonic and unresponsive to massage and intravenous administration of uterotonics. Immediate neonatal resuscitation, including bag and mask ventilation for 20 minutes, was required followed by continuous nasal positive airway pressure (CPAP) for additional 20 minutes. Arterial pH was 6.69, and venous pH was 6.73. ![]() Apgar score was 0, 4, and 4 at 1, 5 and 10 minutes, respectively. The baby was extracted 5 minutes later and was hypotonic and unresponsive. Soon after, the patient lost consciousness and required an emergency caesarean section for fetal-maternal rescue. The fetus was bradycardic (60 bpm) despite resuscitation measures that included phenylephrine administration (300 µg), oxytocin discontinuation, left lateral decubitus position and oxygen supply. Hypotension (90/39 mmHg), tachycardia (108/minute) and cyanosis were also noticed. Soon after the initial bolus administration of 1 mL of 0.25% bupivacaine and 20 µg fentanyl in the intrathecal space, the patient complained of nausea. Five hours later, she had spinal-epidural analgesia to relieve pain due to uterine contractions. She had artificial rupture of the membranes. She had cervical ripening with a Foley catheter for 24 hours followed by oxytocin administration. Ī 31-year-old healthy primigravida at 40 weeks of gestation was admitted to the delivery room for labor induction due to fetal macrosomia. Over the last few years, publications describing simulation-based training programs for obstetric crisis have proved to be efficient and allow better recognition and care of critical obstetric situations. We report a case of AFE with favorable outcome due to fast and efficient multidisciplinary care, emphasizing the benefit of having been trained for such emergency situations. In a situation of severe systemic disease, maternal survival is largely dependent on the combined efficacy of gynecological and anesthetic teams. Moreover, AFE clinical presentation can range from moderate organ dysfunction to cardiovascular collapse with disseminated intravascular coagulation (DIC), which can be mistaken with other conditions. According to literature, its incidence is difficult to establish due to the various criteria used to assess the diagnosis. Simulation and team training programs for obstetrical emergency management.Īmniotic fluid embolism (AFE) is a rare, unpredictable and unpreventable event with high maternal and fetal morbidity and mortality. Outcome was favorable due to fast and efficient multidisciplinary care,Įmphasizing the benefit of having been trained for such situations through Which was complicated by uterine atony and DIC requiring hysterectomy. Due to a loss of consciousness soon after epidural anesthesiaĪssociated to fetal bradycardia, an emergency caesarean section was performed Report a case of AFE in a healthy woman admitted to the delivery room for labor In a situation of severe systemic disease, maternal survival is largelyĭependent on the combined efficacy of gynecological and anesthetic teams. Presentation is nonspecific ranging from moderate organ dysfunction to cardiovascularĬollapse with disseminated intravascular coagulation (DIC), which can lead toĭeath. Amniotic fluid embolism (AFE) is a rare, unpredictable and unpreventableĮvent with high maternal and fetal morbidity and mortality.
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