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An Unusual Presentation of an Amniotic Fluid Embolism: Fetal Bradycardia As the First Sign.

作者信息

Wang Vicki, Dhoon Taizoon Q, Steller John, Carusillo Dominic, Rahimian Ramin, Vakharia Shermeen, Rinehart Joseph

机构信息

Anesthesiology and Perioperative Medicine, UCI Health, Orange, USA.

Anesthesiology, UCI Health, Orange, USA.

出版信息

Cureus. 2024 Aug 19;16(8):e67222. doi: 10.7759/cureus.67222. eCollection 2024 Aug.


DOI:10.7759/cureus.67222
PMID:39295719
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11410296/
Abstract

Amniotic fluid embolism (AFE) is a potentially fatal maternal condition demanding awareness from obstetricians and anesthesiologists regarding its different manifestations. The typical presentation involves maternal respiratory distress, cardiovascular collapse, neurological changes, and coagulopathy followed by fetal distress. This unusual case study emphasizes that fetal compromise may precede maternal decompensation as the initial sign of AFE. Fetal distress is a known symptom of AFE and is typically seen due to cardiorespiratory issues that lead to reduced uteroplacental perfusion, resulting in fetal hypoxia. In the case presented, fetal bradycardia occurred before any visible maternal symptoms, suggesting that fetal distress could be induced by factors independent of the mother's cardiopulmonary status. A 34-year-old healthy G4P2012 at 41 weeks and 2 days gestation who was initially laboring on the floor was emergently taken to the operating room for a cesarean delivery due to fetal bradycardia. Around the time the fetus was delivered, the patient displayed seizure activity, followed by a complete loss of consciousness and cardiac arrest. The patient was intubated and underwent cardiopulmonary resuscitation and defibrillation, subsequently converting to a wide complex tachycardia. In the operating room, there was evidence of heavy vaginal bleeding, uterine atony, and a fulminant form of disseminated intravascular coagulopathy (DIC), which required aggressive management over the next four hours. After achieving hemodynamic stability, the patient was transferred to the surgical intensive care unit (SICU), extubated on day 3, and discharged home on day 8.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb99/11410296/6706172b63ae/cureus-0016-00000067222-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb99/11410296/6706172b63ae/cureus-0016-00000067222-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb99/11410296/6706172b63ae/cureus-0016-00000067222-i01.jpg

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[1]
An Unusual Presentation of an Amniotic Fluid Embolism: Fetal Bradycardia As the First Sign.

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[2]
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[4]
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[8]
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[9]
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[10]
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本文引用的文献

[1]
Shock-Associated Systemic Inflammation in Amniotic Fluid Embolism, Complicated by Clinical Death.

Pathophysiology. 2023-2-21

[2]
Immune storm and coagulation storm in the pathogenesis of amniotic fluid embolism.

Eur Rev Med Pharmacol Sci. 2021-2

[3]
Antifibrinolytic drugs for treating primary postpartum haemorrhage.

Cochrane Database Syst Rev. 2018-2-20

[4]
Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen.

Case Rep Obstet Gynecol. 2017

[5]
Amniotic fluid embolism: Pathophysiology from the perspective of pathology.

J Obstet Gynaecol Res. 2017-4

[6]
Therapeutic application of C1 esterase inhibitor concentrate for clinical amniotic fluid embolism: a case report.

Clin Case Rep. 2015-7

[7]
Amniotic fluid embolism.

Anesth Analg. 2009-5

[8]
Fetal bradycardia and disseminated coagulopathy: atypical presentation of amniotic fluid emboli.

Acta Anaesthesiol Scand. 2004-10

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