Wang Vicki, Dhoon Taizoon Q, Steller John, Carusillo Dominic, Rahimian Ramin, Vakharia Shermeen, Rinehart Joseph
Anesthesiology and Perioperative Medicine, UCI Health, Orange, USA.
Anesthesiology, UCI Health, Orange, USA.
Cureus. 2024 Aug 19;16(8):e67222. doi: 10.7759/cureus.67222. eCollection 2024 Aug.
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.
羊水栓塞（AFE）是一种可能致命的孕产妇疾病，要求产科医生和麻醉医生了解其不同表现。典型表现包括孕产妇呼吸窘迫、心血管崩溃、神经功能改变和凝血病，随后出现胎儿窘迫。这个不寻常的病例研究强调，胎儿窘迫可能先于孕产妇失代偿，成为羊水栓塞的初始迹象。胎儿窘迫是羊水栓塞的已知症状，通常是由于心肺问题导致子宫胎盘灌注减少，从而引起胎儿缺氧。在本病例中，胎儿心动过缓发生在任何明显的孕产妇症状出现之前，这表明胎儿窘迫可能由与母亲心肺状态无关的因素引起。一名34岁、孕41周零2天的健康经产妇（G4P2012），最初在产房分娩，因胎儿心动过缓紧急送往手术室进行剖宫产。在胎儿娩出前后，患者出现癫痫发作，随后完全失去意识并发生心脏骤停。患者接受了气管插管，并进行了心肺复苏和除颤，随后转为宽QRS波心动过速。在手术室里，有大量阴道出血、子宫收缩乏力和暴发性弥散性血管内凝血（DIC）的迹象，在接下来的四个小时里需要积极处理。在血流动力学稳定后，患者被转至外科重症监护病房（SICU），第3天拔管，第8天出院回家。
