Long Miranda, Martin Jane, Biggio Joseph
Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA.
The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2022 Fall;22(3):253-257. doi: 10.31486/toj.21.0107.
Amniotic fluid embolism (AFE) is a rare cause of severe maternal morbidity and mortality. No well-studied protocols are available for management of AFE. We present a case of cardiac arrest secondary to presumed AFE and the use of atropine-ondansetron-ketorolac (AOK). A 34-year-old gravida 4, para 2012 underwent a repeat cesarean section at 39 weeks of gestation. After delivery of the placenta, hypoxia and hypotension developed, followed by cardiac arrest. Protocols for management of maternal cardiac arrest were followed. Echocardiogram demonstrated right ventricular dilation and hypokinesis. AOK was administrated during prolonged cardiac arrest, and spontaneous circulation returned. The patient was extubated on postoperative day 3 and discharged on postoperative day 10 without neurologic deficits. Management of AFE should include consideration of the addition of AOK to typical guidelines.
羊水栓塞（AFE）是导致孕产妇严重发病和死亡的罕见原因。目前尚无针对羊水栓塞管理的经过充分研究的方案。我们报告一例因疑似羊水栓塞继发心脏骤停并使用阿托品 - 昂丹司琼 - 酮咯酸（AOK）的病例。一名34岁、孕4产2（2012）的孕妇在妊娠39周时接受了再次剖宫产。胎盘娩出后，出现缺氧和低血压，随后发生心脏骤停。遵循了孕产妇心脏骤停的管理方案。超声心动图显示右心室扩张和运动减弱。在长时间心脏骤停期间给予AOK，自主循环恢复。患者术后第3天拔管，术后第10天出院，无神经功能缺损。羊水栓塞的管理应包括考虑在典型指南中添加AOK。
