![]() ![]() AFE should be suspected in any pregnant patient, specifically those with ruptured membranes, who develop sudden onset dyspnea with hypoxia, acute hypotension and/or cardiac arrest followed by a profound coagulopathy. The differential diagnosis includes air or thrombotic pulmonary emboli, septic shock, aspiration pneumonia, acute myocardial infarction, placental abruption, eclampsia, complication of tocolytic therapy with β-sympathomimetics, transfusion reaction and local anaesthetic toxicity 4. Any condition that presents as acute cardiorespiratory collapse or massive hemorrhage in the peripartum period must be systematically evaluated. The diagnosis is therefore made by exclusion of other causes. The diagnosis of AFE is based on its clinical presentation and supportive laboratory studies. There is no one specific test that can confirm this syndrome. Autopsy was not performed.Īmniotic fluid embolism (AFE), first described by Meyer in 1926, is a topic of great concern in obstetrics today because of its dramatic presentation and high rate of mortality 3. The patient was declared dead 40 minutes after the onset of resuscitative efforts. Then, maternal bradycardia and asistoli was developed and cardiopulmonary resuscitation (CPR) was performed. During operation, the patient developed severe haemorrhage and shock necessitating massive blood transfusion. Caesarean section was performed immediately, but the male baby died. Supportive measures, including fluid resuscitation, inotropic support and plasma, were administered. Cardiotocography revealed signs of foetal distress and ultrasound showed oligohydramnios of the foetus. ![]() Laboratory values revealed mild coagulopathy. A central venous catheter was inserted in the right internal jugular vein and central venous pressure was 8 mmHg. She was transferred to intensive care unit. Endotracheal intubation was immediately performed, and the patient was mechanically ventilated. The electrocardiogram showed only a sinus tachycardia. The chest x-ray revealed central bilateral pulmonary oedema. Arterial blood gas analysis showed a severe hypoxaemia. She was semi-orientated, tachycardic, tachypnoeic, dyspnoeic, hypotensive and cyanotic. Vaginal examination revealed a cervix dilated 3-4 cm, effaciated 60%, and the fetal head stated at minus 2. Her antepartum obstetric history was unremarkable, but her past medical history was significant for a diagnosis of asthma and some drug allergies. ![]() A 32-year-old nulliparous woman at 40 weeks' of gestation, was admitted to the our emergency service with complaints of vaginal bleeding and pain. ![]()
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