Department of Medicine, McGill University, Montreal, QC, Canada.
Division of Critical Care, Department of Medicine, Jewish General Hospital, McGill University, 3755 ch. de la Côte-Sainte-Catherine Rd, Suite H-364.1, Montreal, QC, H3T 1E2, Canada.
Can J Anaesth. 2021 Oct;68(10):1541-1548. doi: 10.1007/s12630-021-02065-4. Epub 2021 Jul 26.
Amniotic fluid embolism (AFE) is a rare, but often fatal condition characterized by sudden hemodynamic instability and coagulopathy occurring during labour or in the early postpartum period. As the mechanisms leading to shock and the cardiovascular effects of AFE are incompletely understood, the purpose of this case series is to describe how AFE presents on echocardiography and review limited reports in the literature.
We describe three cases of AFE at the Jewish General Hospital, a tertiary care centre in Montreal, Canada. All cases met the Clark diagnostic criteria, which comprise 1) sudden cardiorespiratory arrest or both hypotension and respiratory compromise, 2) disseminated intravascular coagulation, 3) clinical onset during labour or within 30 min of delivery of the placenta, and 4) absence of fever. Two patients had a cardiac arrest and the third developed significant hypotension and hypoxia. In all patients, point-of-care echocardiography at the time of shock revealed signs of right ventricular failure including a D-shaped septum, acute pulmonary hypertension, and right ventricular systolic dysfunction.
This case series and literature review of AFE emphasizes the importance of echocardiography in elucidating the etiology of maternal shock. The presence of right ventricular failure may be considered an important criterion to diagnose AFE.
羊水栓塞（AFE）是一种罕见但常致命的疾病，其特征为在分娩期间或产后早期突然出现血流动力学不稳定和凝血功能障碍。由于导致休克的机制以及 AFE 的心血管效应尚未完全阐明，本病例系列旨在描述 AFE 在超声心动图上的表现，并回顾文献中有限的报告。
我们描述了加拿大蒙特利尔三级保健中心犹太综合医院的 3 例 AFE 病例。所有病例均符合 Clark 诊断标准，包括 1）突然发生心肺骤停或同时存在低血压和呼吸窘迫，2）弥漫性血管内凝血，3）在分娩期间或胎盘娩出后 30 分钟内发病，4）无发热。2 例患者发生心脏骤停，第 3 例患者出现明显低血压和缺氧。在所有患者中，休克时即时床旁超声心动图显示右心室衰竭的迹象，包括 D 形室间隔、急性肺动脉高压和右心室收缩功能障碍。
本病例系列和 AFE 的文献复习强调了超声心动图在阐明产妇休克病因中的重要性。右心室衰竭的存在可被视为诊断 AFE 的一个重要标准。
