Amniotic fluid embolism followed by cardiac arrest- A case report and review of the literature

Abstract

Objective To explore the clinical features, diagnosis, treatment and the outcome of amniotic fluid embolism (AFE). Methods We retrospectivly studied the clinical manifestation, diagnosis, treatment and the outcome of 1 case of AFE in Peking University Shenzhen Hospital and previous 61 literature reports. Results We reported a case of AFE followed by cardiac arrest in a 39 years old woman who was admitted to the hospital with premature rupture of membranes at 39 weeks of gestation. Cardiopulmonary resuscitation and cesarean were performed immediately. The patient and the infant were healthy. The common aura symptoms of patients with AFE included polypnea (27 cases, 44.3%), cyanosis (14 cases, 21.3%), drop of blood pressure (11 cases, 18.0%), altered mental status (9 cases, 14.8%) and dysphoria (8 cases, 13.1%). The common clinical manifestations were circulatory dysfunction (52 cases, 85.2%), respiratory dysfunction (47 cases, 77.0%) and blood dysfunction (39 cases, 63.9%). Eight cases (13.1%) used extracorporeal membrane oxygenation (ECMO), and the prognosis was excellent. Of the 61 patients with AFE, 16 cases (26.2%) died and 45 cases (73.8%) survived. There are 35 cases described neonatal outcome, 24 cases(57.4%)were healthy, 4 cases (6.6%) were dead, 7 cases (11.5%) were transferred to the neonatal intensive care unit (NICU) and the outcome was unknown. Conclusions The main manifestations of AFE are circulatory failure, respiratory failure and coagulation failure. Early identification, high quality cardiopulmonary resuscitation and opportune termination of pregnancy are the main treatment methods. Key words: Amniotic fluid embolism; Pregnancy complications; Cardiac arrest