Life-threatening Obstetric Emergency Research Articles

Clinical Implications of HELLP Syndrome in Anesthesia Management of Preeclamptic Pregnant Mothers: A Literature-Based Review

BACKGROUND:Hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome is a serious life-threatening obstetric emergency accompanied with heterogeneous presentation and multisystem dysfunction. It increases the perils of fetal morbidity and mortality and requires complex clinical management during medical and surgical interventions. Hence, it remains a major challenge for anesthesia providers during perioperative management. The current study aimed to explore the main clinical implications of HELLP syndrome in anesthesia management of preeclamptic pregnant mothers who underwent cesarean section.METHODOLOGY:An exhaustive search of the literature was conducted on the available relevant databases, such as PubMed, Google Scholar, and Cochrane Reviews, published from 1990 to 2023, using the terms HELLP syndrome, cesarean section, and anesthetic challenges/complications. All observational studies, randomized controlled trials (RCTs), cohorts, and nonrandomized studies on HELLP syndrome and anesthetic challenges during cesarean section reported in English were included. Nonpregnant mothers with HELLP syndrome and studies with no relevant reports or abstracts, case reports, or case studies were excluded.RESULTS:A systematic search of relevant databases identified 82 studies: 60 from PubMed, 18 from Google Scholar, and 4 from Cochrane Reviews. After removing duplicates, 48 studies were screened and recorded. Eighteen studies were assessed for eligibility after their titles and abstracts were reviewed. Twelve studies were excluded from the current study, as it did not fulfill the inclusion criteria. Finally, six studies, four retrospective studies, one prospective observational study, and one RCT, were included and reviewed.CONCLUSION:Perioperative anesthetic care in patients with HELLP syndrome remains a challenge. Hence, anesthetic techniques should be selected based on the severity of the condition, patient status, urgency surgery, fetal conditions, coagulation status, and safe platelet counts.

Life-Threatening Obstetrical Emergency: Spontaneous Uterine Rupture Associated with Placenta Percreta in the First Trimester of Pregnancy—Case Report and Literature Review

Background: The greatest risk for the occurrence of the placenta accreta spectrum (PAS) is represented by uterine scars, which most frequently result after cesarean sections. Uterine rupture is a rare condition and appears mainly in the third trimester of pregnancy. The association between these two conditions is extremely rare in the first trimester of pregnancy. Methods: We performed a systematic review of abnormal placental adhesions and spontaneous uterine ruptures in the first trimester of pregnancy. We also reported a case of spontaneous uterine rupture in a 12-week pregnancy that presented with massive hemoperitoneum and hemorrhagic shock. Results: A 33-year-old patient with two previous cesarean sections, at the twelfth week of pregnancy at the time to this visit to the emergency room, presented with syncope and intense pelvic–abdominal pain. A clinical examination and ultrasound scan established the diagnosis of hemoperitoneum and hemorrhagic shock. Surgical exploration was performed, uterine rupture was identified, and hemostasis hysterectomy was necessary. The histopathological results showed placenta percreta. There have been eight reported cases of spontaneous uterine rupture in the first trimester of pregnancy associated with PAS. In these cases, it was found that 62.5% of the patients had undergone at least one cesarean section in the past; in 75% of the cases, hysterectomy was performed; and, in 87.5% of the cases, the presence of placenta percreta was confirmed. Conclusions: A high rate of cesarean sections determines the increase in the incidence of placenta accreta spectrum disorders. The possible life-threatening complications caused by this pathology can be observed in early pregnancies.

Posterior reversible encephalopathy syndrome in a patient with late postpartum eclampsia.

Posterior reversible encephalopathy syndrome (PRES) is a rare complication commonly associated with headache and acute changes in blood pressure that results from a variety of causes, culminating in vasogenic cerebral edema in the occipital and parietal lobes of the brain. We report here a woman who suffered from headache, generalized tonic-clonic seizures, and cortical blindness in the late postpartum period. Posterior reversible encephalopathy syndrome. The patient was treated with amlodipine besylate tablets for hypertension, dehydration with mannitol and glycerin fructose, and antispasmodic treatment with sodium valproate and oxcarbazepine. On day 2, the patient became conscious, headache and vision improved. One week later, symptoms and signs disappeared, blood pressure returned to normal, and brain MRI lesions disappeared in re-examination. Eclampsia associated with PRES is reversible in most cases, but it is a serious and potentially life-threatening obstetric emergency. If adequate treatment is provided in a timely manner, most women will make a full recovery. Attention needs to be paid to timely and adequate treatment, as well as appropriate follow-up and support for patients with PRES.

Acute puerperal uterine inversion

Uterine inversion is often accompanied by postpartum hemorrhage and hypovolemic shock. Morbidity and mortality occur in 41% of cases. Early recognition and management are of utmost importance. Successful treatment depends on timely recognition. Management should include resuscitation of maternal hypovolemic shock and repositioning of the inverted uterine fundus. Uterine inversion is a rare but potentially life-threatening obstetric emergency.

Ovarian Hyperstimulation Syndrome: A Case Report

BackgroundOvarian hyperstimulation syndrome is a rare, life-threatening obstetric emergency. Early recognition and prompt treatment of ovarian hyperstimulation syndrome are essential owing to the risk of long-term complications associated with this condition. Case PresentationA 30-year-old female presented to the emergency department with a chief complaint of abdominal pain. After assessment and diagnostic testing, she was diagnosed as having ovarian hyperstimulation syndrome. The patient was admitted for 24-hour observation. The patient was discharged home with instructions to follow up with an outpatient reproductive medicine clinic. One month after her visit to the emergency department, the patient has not had any complications related to the diagnosis. ConclusionThis manuscript outlines the case of a patient presenting to the emergency department with ovarian hyperstimulation syndrome that was promptly recognized and treated. It is important for emergency nurses to quickly identify the risk factors and clinical presentation of ovarian hyperstimulation syndrome to decrease the risk of long-term complications.

Acute Uterine Inversion Complicating Mid-Trimester Unsafe Abortion in a Teenage Nigerian Girl

Uterine inversion is a rare but life-threatening obstetric emergency, complicating 1 in 2,000 to 1 in 50,000 deliveries. Very rarely, this condition also complicates unsafe abortion. A case of acute complete (fourth-degree) uterine inversion, with gangrene of the uterus in an 18-year-old nulliparous girl who presented to the Gynaecologic Emergency Unit of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, in hypovolemic shock from massive haemorrhage following unsafe mid-trimester termination of unwanted pregnancy is reported. She was adequately resuscitated, and a vaginal hysterectomy was performed. The patient was discharged following an uneventful postoperative period. This case highlights the consequences of the high unmet need for family planning and the restrictive abortion laws in Nigeria, limiting access to effective contraception and safe abortion services, thereby increasing the risk of maternal mortality and morbidity from complications of unsafe abortion

Prevalence and determinants of ectopic pregnancy in Ethiopia: Systematic review and meta-analysis

Background: Ectopic pregnancy is a life-threatening obstetric emergency, and is a major health problem for women of fertile age. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence, determinant factors, and outcomes of ectopic pregnancy among fertile age women in Ethiopia. Method: International databases (MEDLINE/Pub Med, Hinari, Scopus, Google scholar, African journals, and literatures were searched and nine eligible cross sectional and two case control studies were included in this systematic review and meta-analysis. Eggers test and funnel plot were computed to check publication bias across the studies. Publication bias was computed using a funnel plot and eggers test. Heterogeneity of the studies was checked using Cochrane Q-test and I2 statistic. Results: The pooled prevalence of ectopic pregnancy in Ethiopia was 3.61% (95%CI: 2.24–4.98, I2 = 89.2.0%, p < 0.001). Having cesarean section scar (AOR = 7.44, 95%CI: 5.48–10.09), single marital status (AOR = 5.71, 95%CI: 4.76–6.85), history of sexually transmitted infection (AOR = 4.68, 95%CI: 3.04–7.19), history of abortion (AOR = 3.89, 95%CI: 3.35–4.52), history of ectopic pregnancy (AOR = 5.74, 95%CI: 3.81–8.65), and emergency contraceptive use (AOR = 8.72, 95%CI: 2.90–26.20) were the determinant factors for the occurrence of ectopic pregnancy. Conclusion: This systematic review and meta-analysis showed that the prevalence of ectopic pregnancy was high in Ethiopia. Thus, educating women to limit the number of sexual partners, smoking cessation, using a condom during sex helps prevent sexually transmitted infections and the risk of pelvic inflammatory disease is crucial.

Study of cases of rupture uterus and its maternal and perinatal outcome in a tertiary care institute

Background: Rupture of the pregnant uterus refers to complete disruption of all uterine layers, including the serosa. It is a life-threatening obstetric emergency and a major cause of maternal and perinatal morbidity and mortality. In India, in advanced setups the incidence of rupture preceded by obstructed labour is decreasing, in rural parts where there is inadequate care, lack of communication and transport, home deliveries by untrained dais incidence of rupture uterus is still high. So, the study is to evaluate the etiological factors, incidence, management modalities and maternal and perinatal outcome. Methods: A hospital based prospective cross-sectional study of 201 cases of rupture uterus and maternal and Perinatal outcome was conducted in the department of Obstetrics and Gynecology in government tertiary reference center, Kolkata, West Bengal India from March 2020 to April 2021. Total 201 cases of rupture uterus fulfilling the inclusion criteria were included in the study. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: Majority of the patients 180 (89.55%) have incomplete rupture and only 21 (10.45%) have complete rupture. In regard to treatment done 64 (31.84%) treated with total hysterectomy, 60 (29.85%) treated with subtotal hysterectomy, 51 (25.37%) treated with repair with BLTL and 26 (12.94%) treated with repair without BLTL. All mothers 201 (100%) were repeated transfusion followed by Bladder Injury 18 (8.96%), Wound Sepsis 15 (7.46%). Maximum fetal complication was Perinatal Asphyxia 96 (47.76%) followed by Sepsis 7 (3.48%), Jaundice 14 (6.97%). Conclusions: Uterine rupture is still a major public health problem in the developing countries, that has a high potential for causing perinatal and maternal morbidity and mortality. Behavioural change strategies should be employed in educating women and their spouse through peer education, group engagement and culturally sensitive and acceptable strategies on the need to attend antenatal clinics, and have their deliveries in hospitals equipped with trained and skilled personnel to supervise pregnancy, labour and delivery.

UTILIZATION OF POINT-OF-CARE ULTRASOUND AND ROTATIONAL THROMBOELASTOMETRY TO DIAGNOSE AND MANAGE AMNIOTIC FLUID EMBOLISM PRESENTING AS POST-PARTUM HEMORRHAGE AND CARDIAC ARREST

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Amniotic fluid embolism (AFE) is a life-threatening obstetrical emergency. Despite its clinical significance there is little guidance on diagnosis and management[1, 2, 3]. In the absence of more specific diagnostic guidelines, point-of-care ultrasound (POCUS) in combination with rotational thromboelastometry (ROTEM) can aid in the diagnosis and management of AFE and have a significant impact on clinical outcomes[4]. CASE PRESENTATION: A 29-year-old, previously healthy, gravida 1 female presented at 39 weeks' gestation for induction of labor due to gestational diabetes and concerns surrounding the COVID-19 pandemic. The patient was laboring for approximately 10 hours when she suddenly started to feel nauseous, lightheaded, and subsequently suffered a syncopal episode complicated by fetal bradycardia. She was tachycardic, poorly responsive and in respiratory distress. She was transferred to the operating room (OR) for emergency Cesarean section. After the uterine incision, the intubated patient developed circulatory collapse followed by a sinus tachycardia pulseless electrical activity (PEA) arrest. Chest compressions were initiated, and the hospital code/resuscitation team was called to the OR. The patient started bleeding from her incision leading to an initial diagnosis of hemorrhagic shock. The code team, equipped with point-of-care ultrasound skill obtained an apical 4-chamber view (Figure 1) that revealed a severely dilated and hypokinetic right ventricle, and a hyperdynamic, underfilled left ventricle. The ultrasound findings in combination with significant bleeding were felt to be consistent with AFE not hemorrhagic shock and the extracorporeal membrane oxygenation (ECMO) team was activated for bedside cannulation. ROTEM (Figure 2) demonstrated markedly prolonged clotting time, prolonged clotting formation time and very low clot amplitude consistent with DIC, further supporting the diagnosis of AFE and prompted the difficult decision to withhold heparin after VA-ECMO cannulation. Following stabilization, patient was transferred to the intensive care unit with a diagnosis of AFE complicated by DIC and post-partum hemorrhage. She left the hospital with no physical or neurologic deficits 31 days later with her healthy baby boy. DISCUSSION: The description of POCUS use during cardiovascular resuscitation in the setting of AFE and other obstetric emergencies is rare. Identifying a dilated right ventricle on ultrasound can narrow the diagnosis of circulatory collapse in the peripartum patient to pulmonary embolism (PE) and AFE. ROTEM can help differentiate AFE from PE by identifying DIC with one study estimating the occurrence of DIC in PE at 1 % compared to 30-77% in AFE[5]. CONCLUSIONS: The use of POCUS and ROTEM in the diagnosis and management of AFE can guide lifesaving clinical decision making in the peripartum patient who develops circulatory collapse followed by cardiac arrest. REFERENCE #1: Sitaula S, Das D, Sitaula S, Chhetry M. Amniotic fluid embolism: A rare cause of maternal collapse-A case report. Clin Case Rep. 2020;8(12):3359-3361. Published 2020 Oct 26. doi:10.1002/ccr3.3433 REFERENCE #2: Loughran JA, Kitchen TL, Sindhakar S, Ashraf M, Awad M, Kealaher EJ. Rotational thermoelectrometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism. Int J Obstet Anesth. 2019;38:127-130. doi:10.1016/j.ijoa.2018.09.001 REFERENCE #3: Rath WH, Hoferr S, Sinicina I. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment. Dtsch Arztebl Int. 2014;111(8):126-132. doi:10.3238/arztebl.2014.0126 DISCLOSURES: No relevant relationships by Angela Phillips, source=Web Response No relevant relationships by David Tierney, source=Web Response

Awareness of euglycaemic diabetic ketoacidosis during pregnancy prevents recurrence of devastating outcomes: a case report of two pregnancies in one patient

BackgroundEuglycaemic diabetic ketoacidosis (DKA) during pregnancy is a life-threatening obstetric emergency. It requires early identification and prompt action. Obstetricians’ knowledge about symptoms, diagnostic pitfalls and management during pregnancy and delivery need to be improved. We report a case of a young diabetic woman developing severe euglycaemic DKA in two consecutive pregnancies; the first pregnancy resulted in the most deviating outcome (i.e., intrauterine death), while the second pregnancy resulted in the delivery of a healthy newborn. Thus, the novelty of the case presented here is the possibility to demonstrate how the management of DKA in pregnancy can dramatically change outcomes.Case presentationWe report a case of a young diabetic woman in whom DKA was concealed by hyperemesis and oesophageal reflux. This woman presented to our delivery unit with severe euglycaemic DKA during her first pregnancy. While the mother’s condition could be successfully stabilized, the foetus died shortly after admission. Two years later, the same woman presented with similar problems. Repeated episodes of mild euglycaemic DKA could be successfully managed with consequent interdisciplinary treatment and close observation, leading to a good pregnancy outcome, i.e., the birth of a healthy child.ConclusionAwareness of euglycaemic DKA needs to be increased to reduce the risk of severe complications during pregnancies in diabetic women. This case report demonstrates that increased awareness of DKA with immediate recognition and a successful multidisciplinary approach are mandatory for an positive pregnancy outcomes.

Cesarean Scar Ectopic Pregnancy: A Case Report

BackgroundA cesarean scar pregnancy is a rare, life-threatening obstetric emergency. Early recognition and prompt treatment of cesarean scar pregnancy is essential because of the risk for long-term reproductive complications associated with this condition. Case PresentationA 33-year-old gravida 6 para 5 female presented to the emergency department with pain to the suprapubic area. Following assessment and diagnostic testing, she was diagnosed with a cesarean scar pregnancy. The patient was admitted to the women's services department where she received a multidose regimen of methotrexate. The patient was discharged home, and no further surgical interventions were necessary. Two months after her visit to the emergency department, the patient has not had any complications related to the cesarean scar pregnancy. ConclusionThis manuscript outlines the case of a patient presenting to the emergency department with a cesarean scar pregnancy that was promptly recognized and treated. It is important for emergency nurses to quickly recognize the risk factors and clinical presentation of a cesarean scar pregnancy to reduce maternal morbidity and mortality.

URIC ACID LEVEL AS A PREDICTOR OF SEVERITY IN PREGNANT WOMEN WITH SEVERE PREECLAMPSIA

Preeclampsia is a pregnancy syndrome affecting multiple organ systems, characterized by hypertension and proteinuria after 20 weeks of gestation. The incidence of preeclampsia is estimated to be 3-10% of pregnancies worldwide and is the leading cause of death for pregnant women. Preeclampsia is a life-threatening obstetric emergency, so it needs prompt and precise treatment to prevent morbidity and mortality. WHO estimates that the incidence of preeclampsia is seven times higher in developing countries (2.8% of live births) than in developed countries 1,2 (0.4%).

Clinical course of ectopic pregnancy in a tertiary center: Observational study

Objective: Ectopic pregnancy is a life-threatening obstetric emergency. The objective of the study was to highlight the incidence, clinical profile and the management of ectopic pregnancy. The study was conducted in Obstetrics and Gynecology department of ESIC PGIMSR Delhi over one year. It was an observational study. Materials and Methods: Pregnant women presenting in gynaecology emergency with pain abdomen or bleeding per vaginum or history suggestive of ectopic pregnancy in first trimester were assessed for intrauterine or extrauterine pregnancy. Written informed consent was obtained from each patient prior to the treatment. All pregnant women with intrauterine pregnancies were excluded. 77 pregnant women were found to have extrauterine pregnancy. All Hemodynamically stable cases were managed conservatively. Hemodynamically compromised cases were managed surgically. Surgical procedure performed was salpingectomy. These cases were followed with weekly beta hCG till it normalized. Outcome: Incidence, Age, Parity and the treatment given. Results: Incidence of ectopic pregnancy in the institution was 2.01%. 46.7% cases were among age group 20-30 years. Multigravida 46.7% were having more ectopic pregnancy. 99% of extrauterine pregnancy were located in the Fallopian tubes. 38.9% presented between 4-6 weeks period of gestation 10.3% managed conservatively. 11.6% were chronic ectopic pregnancies were operated. Salpingectomy was the main surgical procedure. Conclusion: Thus, high index of clinical suspicion of ectopic pregnancy must be kept in mind. Early diagnosis and prompt treatment can help in reducing maternal mortality and morbidity. Keywords: Ectopic pregnancy, Salpingectomy, Fallopian tube.

A case of third degree hemorrhagic shock due to total subacute uterine inversion after delivery

Uterine inversion is a rare, but life-threatening obstetric emergency. We describe a case of total subacute uterine inversion in settings with limited resources. A multiparous (P4) 29-year-old woman with history of delivery assisted by a traditional birth attendant who used the fundal pressure technique 4 days before admission was referred due to postpartum hemorrhage. She had low blood pressure, tachycardia, and lethargic. A protruding mass from the vaginal introitus with active bleeding was visible. She diagnosed with third degree hemorrhagic shock due to total subacute uterine inversion. Resuscitation was initiated immediately and manual uterine repositioning was performed under general anesthesia. After two failed attempts, a laparotomy was performed to apply traction to the round ligaments and an incision on the cervical ring by using Allis clamps. The inversion was resolved. Next, subtotal hysterectomy was done to stop bleeding and infection.

Laparotomic manual replacement for uterine inversion following vaginal birth: a case report

Background: Puerperal uterine inversion is a potentially life-threatening obstetric emergency, and there is a lack of knowledge concerning its optimal management. Case: This report describes a case of successful manual replacement via laparotomy for acute uterine inversion following vaginal birth. Conclusions: Our successful experience with laparotomic manual replacement in this case may provide a reference for the management of uterine inversion in clinical practice.

Burden of Uterine Rupture and Its Determinant Factors in Ethiopia: A Systematic Review and Meta-analysis

Background. Uterine rupture is a life-threatening obstetrical emergency, which results in serious undesired maternal and perinatal complications in resource-limited countries, mainly in Ethiopia. The prevalence, determinants, and outcomes of uterine rupture described by different studies were highly inconsistent in Ethiopia. Therefore, this systematic review and meta-analysis is aimed at estimating the pooled prevalence, determinants, and adverse outcomes of uterine rupture in Ethiopia. Methods. Studies were searched from international databases (PubMed/MEDLINE, HINARI, Cochrane library, Google Scholar, and web of science) and Ethiopian universities’ digital libraries (Addis Ababa University, University of Gondar, and Harameya University). All observational studies were included. A total of 15 studies that fulfill the inclusion criteria were included in this meta-analysis. Data were extracted by two reviewers and exported to STATA version 11 for analysis. The I 2 statistics were used to assess heterogeneity across the studies. Publication bias was examined by using Egger’s test and funnel plot. The pooled prevalence of uterine rupture and its outcomes were estimated by using a random effects model. The associations between determinants and uterine rupture were evaluated by using both random and fixed-effect models. Results. In this meta-analysis, a total of 15 studies with 92,394 study participants were involved. The pooled prevalence of uterine rupture was 2.37% in Ethiopia. Obstructed labor ( OR = 3.03 ; 95 % CI = 2.52 , 3.63 ), lack of antenatal care follow-up ( OR = 5.79 ; 95 % CI = 2.47 , 13.61 ), duration of labor > 24 hours ( OR = 3.75 ; 95 % CI = 2.24 , 6.29 ), grand multipara ( OR = 10.79 ; 95 % CI = 4.77 , 24.40 ), and being rural residency ( OR = 7.17 ; 95 % CI = 3.90 , 13.16 ) were significantly associated with uterine rupture. Conclusion. The overall prevalence of uterine rupture was high in Ethiopia. Obstructed labor, lack of antenatal care follow-up, duration of labor > 24 hours, grand multipara, and rural residency were determinants of uterine rupture. This study implies the need to develop plans and policies to improve antenatal care follow-up and labor and delivery management at each level of the health system.

Umbilical Cord Prolapse: A Review of the Literature.

Umbilical cord prolapse is a rare occurrence and is a life-threatening emergency for the fetus. These events are unpredictable and unpreventable. Umbilical cord prolapse requires swift diagnosis and management for optimal outcome. The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of this rare but potentially life-threatening event. A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. There were 200 articles identified, with 53 being the basis of review. Multiple risk factors for a umbilical cord prolapse have been suggested including fetal malpresentation or abnormal lie, prematurity, multifetal gestation, and polyhydramnios. The diagnosis is largely made by examination and found after rupture of membranes, and most often, examination is prompted by fetal heart rate decelerations. The management of umbilical cord prolapse is expedited delivery; however, there are rare specific scenarios in which immediate delivery is not possible and efforts should be made to relieve cord compression. Rapid identification of an umbilical cord prolapse facilitates management and increases likelihood of an optimal outcome. The management is an expedited delivery with efforts to relieve cord compression until delivery can be achieved. Umbilical cord prolapse is a rare but a life-threatening obstetrical emergency.

Epidemiology of Oxytocin Administration in Out-of-Hospital Births Attended by Paramedics

Aim Primary postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that can be mitigated through the administration of a uterotonic to actively manage the third stage of labor. This study describes the prehospital administration of oxytocin by paramedics following attendance of out-of-hospital (OOH) births. Methods A retrospective analysis was undertaken of all OOH births between the 1st January 2018 and 31st December 2018 attended by the Queensland Ambulance Service. The demographic and epidemiological characteristics of patients that were administered oxytocin and the occurrence of adverse side effects were described. Results In total, 350 OOH births were included in this study with the majority involving multigravidas women (94.3%) and all but two involving singleton pregnancies. Oxytocin was administered following 222 births (63.4%), while 67 patients (19.1%) declined administration preferring a physiological third stage of labor, and in 61 cases (17.4%) oxytocin was withheld by the attending paramedic. There were no documented adverse events or side effects following administration. Oxytocin administration occurred on average 14 minutes (interquartile range 9-25) following the time of birth. The median time from oxytocin administration to placenta delivery was 10 minutes (interquartile range 5-22). Conclusion Oxytocin is well accepted and safe treatment adjunct for the management of the third stage of labor in OOH births and should be considered for routine practice by other emergency medical services.

Amniotic Fluid Embolism in Post Caesarean Section

BACKGROUND: According to WHO, around 73% of maternal deaths globally are caused by direct obstetric causes. The amniotic fluid embolism is a life-threatening obstetric emergency characterized by sudden cardiopulmonary system failure and can be accompanied by Disseminated Intravascular Coagulation (DIC). The amniotic fluid embolism event usually occurs during labor and birth, but can also occur immediately in the post partum period or after pregnancy termination. About 56% of women will not survive for first 2 hours after the acute event. Amniotic fluid embolism is an unpredictable event, so that no prophylactic intervention can be carried out effectively and the handling and enforcement of a diagnosis that still debatable.OBJECTIVE: To report maternal deaths due to amniotic fluid embolism post cesarean sectionMETHOD: Case ReportCASE: Reported case of a 30 years old woman with an initial diagnosis in emergency departement with decreased consciousness due to Severe hypoxia due to Pulmonary emboli due to Amniotic fluid emboli on P2A0L2 post Cesarean Section first day of puerperium. The patient experienced a sudden loss of consciousness accompanied by severe shortness of breath after 6 hours after cesarean section surgery in a private hospital. After initial examination and treatment by administering oxygen through the Nonrebreathing Mask, there was no improvement in the O2 saturation value and then the patient was intubated by the anesthetist. After intubation, the O2 saturation value still does not increase, then the patient suddenly experiences cardiac arrest and followed with cardiac resuscitation for 2 cycles accompanied by resuscitation drugs then the patient returns to spontaneous circulation. From the cardiology department, inotropic therapy was given and echocardiographic investigations were carried out. On echocardiographic examination, they found McConnel's sign which showed suspicios of pulmonary embolism. At the time the patient will be moved to the intensive care unit, the patient experiences a cardiac arrest for the second time, then resuscitation is performed again for 2 cycles, but it does not work and the patient is declared dead.CONCLUSION: Amniotic fluid embolism is an obstetric emergency condition that cannot be predicted and has a high mortality rate. Treatment is supportive to support the cardiopulmonary system and management of coagulopathy that may occur.KEYWORDS: Maternal mortality, Amniotic Fluid Embolism

Amniotic Fluid Embolism in Post Caesarean Section

Background: According to WHO, around 73% of maternal deaths globally are caused by direct obstetric causes. The amniotic fluid embolism is a life-threatening obstetric emergency characterized by sudden cardiopulmonary system failure and can be accompanied by Disseminated Intravascular Coagulation (DIC). The amniotic fluid embolism event usually occurs during labor and birth, but can also occur immediately in the post partum period or after pregnancy termination. About 56% of women will not survive for first 2 hours after the acute event. Amniotic fluid embolism is an unpredictable event, so that no prophylactic intervention can be carried out effectively and the handling and enforcement of a diagnosis that still debatable.Objective: To report maternal deaths due to amniotic fluid embolism post cesarean sectionMethod: Case ReportCase: Reported case of a 30 years old woman with an initial diagnosis in emergency departement with decreased consciousness due to Severe hypoxia due to Pulmonary emboli due to Amniotic fluid emboli on P2A0L2 post Cesarean Section first day of puerperium. The patient experienced a sudden loss of consciousness accompanied by severe shortness of breath after 6 hours after cesarean section surgery in a private hospital. After initial examination and treatment by administering oxygen through the Nonrebreathing Mask, there was no improvement in the O2 saturation value and then the patient was intubated by the anesthetist. After intubation, the O2 saturation value still does not increase, then the patient suddenly experiences cardiac arrest and followed with cardiac resuscitation for 2 cycles accompanied by resuscitation drugs then the patient returns to spontaneous circulation. From the cardiology department, inotropic therapy was given and echocardiographic investigations were carried out. On echocardiographic examination, they found McConnel's sign which showed suspicios of pulmonary embolism. At the time the patient will be moved to the intensive care unit, the patient experiences a cardiac arrest for the second time, then resuscitation is performed again for 2 cycles, but it does not work and the patient is declared dead.Conclusion: Amniotic fluid embolism is an obstetric emergency condition that cannot be predicted and has a high mortality rate. Treatment is supportive to support the cardiopulmonary system and management of coagulopathy that may occur.Keywords: maternal mortality, amniotic fluid embolism