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Amniotic fluid embolus

Abstract

A case report of a 27-yr-old healthy patient for Caesarean section under epidural anaesthesia is presented. The patient suffered an acute cardiorespiratory collapse when the infant’s head was being delivered through the anterior abdominal wall. The patient remained cyanosed after proper tracheal intubation and pulmonary ventilation with 100% O2. Hypotension was difficult to treat but returned to normal 25 min after the event. A pulmonary artery catheter inserted three hours after the event showed normal pressures and a high cardiac output. The patient suffered permanent neurological damage. The differential diagnosis is discussed and current concepts of the aetiology and management of amniotic fluid embolism reviewed.

Résumé

Il s’agit du cas d’une patiente bien portante subissant une césarienne sous anesthésie épidurale. La patiente présente une collapsus cardiorespiratoire aigu au moment où la tête de l’enfant est dégagée à travers la paroi abdominale antérieure. La patiente reste cyanosée après une intubation trachéale (correcte) et une ventilation pulmonaire avec 100% d’O2. L’hypotension est difficile à traiter mais revient à la normale 25 minutes plus tard. Un cathéter Swann-Ganz inséré trois heures après l’évènement donne des pressions normales et un débit cardiaque élevé. La patiente a subi une atteinte neurologique définitive. Le diagnostic différentiel est discuté et les concepts habituels de l’étiologie et du traitement de l’embolie amniotique sont revus.

Abbreviations

PPA:

Pulmonary artery pressure (mmHg)

Pw:

Pulmonary wedge pressure (mmHg)

Pmv:

Pulmonary microvascular pressure (mmHg)

Pla:

Left atrial pressure (mmHg)

Q:

Cardiac output (L · min−1)

PT:

Prothrombin time (sec)

PTT:

Partial thromboplastin time (sec)

FDP:

Fibrin degradation products (μg · ml−1)

AFE:

Amniotic fluid embolus

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Correspondence to William H. Noble.

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Noble, W.H., St-Amand, J. Amniotic fluid embolus. Can J Anaesth 40, 971–980 (1993). https://doi.org/10.1007/BF03010102

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Key words

  • anaesthesia: obstetric
  • embolism: amniotic fluid