Extracorporeal Therapies for Amniotic Fluid Embolism

Obstet Gynecol. 2019 Nov;134(5):989-994. doi: 10.1097/AOG.0000000000003513.

Abstract

Background: Amniotic fluid embolism (AFE) is a catastrophic disease with significant mortality. Because the cardiopulmonary dysfunction associated with AFE is self-limited, the disease could be well suited to the use of extracorporeal therapies.

Case: A woman progressed into cardiac arrest immediately after an elective cesarean delivery. Owing to severe hypoxemia and hypotension, AFE was suspected and peripheral venoarterial extracorporeal membrane oxygenation was quickly initiated. Subsequent evolution was complicated by intrabdominal bleeding, which required massive transfusion and multiple surgeries. The patient recovered well, with a healthy newborn. We have identified 19 similar cases in the literature and present their outcomes as a series.

Conclusion: Extracorporeal therapies can support severely ill women affected by AFE and could be considered even in the presence of disseminated intravascular coagulation and bleeding.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Blood Loss, Surgical
  • Blood Transfusion / methods*
  • Cardiopulmonary Resuscitation / methods*
  • Cesarean Section / adverse effects*
  • Disseminated Intravascular Coagulation* / etiology
  • Disseminated Intravascular Coagulation* / therapy
  • Embolism, Amniotic Fluid* / diagnosis
  • Embolism, Amniotic Fluid* / physiopathology
  • Embolism, Amniotic Fluid* / therapy
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Heart Arrest* / etiology
  • Heart Arrest* / therapy
  • Hemostasis, Surgical / methods
  • Humans
  • Infant, Newborn
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / physiopathology
  • Postoperative Complications* / therapy
  • Pregnancy
  • Pregnancy Outcome
  • Surgical Procedures, Operative / methods
  • Treatment Outcome