Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 610041, Chengdu, P. R. China.
BMC Pregnancy Childbirth. 2022 Mar 26;22(1):252. doi: 10.1186/s12884-022-04572-8.
Amniotic fluid embolism (AFE) is a rare disease that can lead to profound coagulopathy and hemorrhage, especially when combined with the laceration and bleeding of other organs. Intraoperative cell salvage (ICS) has been widely used for treating obstetric hemorrhage, but it remains unclear whether ICS can be used in the treatment of AFE.
We report the case of a 27-year-old woman at 39 weeks' gestation who suddenly developed severe abdominal pain, convulsions, loss of consciousness, and decreased vital signs during labor. Despite an emergency cesarean section being performed, the parturient experienced sudden cardiac arrest. Fortunately, the heart rate spontaneously recovered after effective cardiopulmonary resuscitation (CPR). Further abdominal exploration revealed right hepatic laceration with active bleeding. ICS was performed and the salvaged blood was promptly transfused back to the patient. Subsequently, the patient was diagnosed with AFE based on hypotension, hypoxia, coagulopathy, and cardiac arrest. The patient was transfused with 2899 mL salvaged blood during surgery with no adverse effects. At 60- and 90-day follow-ups, no complaints of discomfort or abnormal laboratory test results were observed in the mother or the baby.
ICS was used to rescue patient with AFE, and ICS did not worsen the condition of patients with AFE. For pregnant women who received CPR, clinicians should explore the presence of hepatic laceration which can be fatal to patients.
羊水栓塞（AFE）是一种罕见的疾病，可导致严重的凝血功能障碍和出血，尤其是合并其他器官的撕裂和出血时。术中回收式自体输血（ICS）已广泛用于治疗产科出血，但用于治疗羊水栓塞的效果尚不清楚。
我们报告了一例 27 岁孕妇的病例，她在 39 周妊娠时突然出现严重腹痛、抽搐、意识丧失和生命体征下降。尽管紧急行剖宫产术，但产妇突然心跳骤停。幸运的是，有效的心肺复苏（CPR）后心率自发恢复。进一步的腹部探查发现右肝撕裂伴活动性出血。行 ICS 并将回收的血液迅速回输给患者。随后，该患者因低血压、缺氧、凝血功能障碍和心跳骤停被诊断为羊水栓塞。手术期间共输注 2899ml 回收血，无不良反应。在 60 天和 90 天的随访中，母亲和婴儿均未出现不适或实验室检查结果异常。
ICS 用于抢救羊水栓塞患者，ICS 并未加重羊水栓塞患者的病情。对于接受 CPR 的孕妇，临床医生应探查是否存在可危及患者生命的肝撕裂。
