French Madison, Bernardes Teresa, Greves Christine C, Shellhammer Shannon, Carlan Steve
Obstetrics, Orlando Regional Medical Center, Orlando, USA.
Internal Medicine, Orlando Regional Medical Center, Orlando, USA.
Cureus. 2024 Dec 6;16(12):e75212. doi: 10.7759/cureus.75212. eCollection 2024 Dec.
Amniotic fluid embolism (AFE) is a rare condition that can have catastrophic maternal and infant consequences. It can lead to rapid multisystem failure and is responsible for a significant portion of maternal deaths. The diagnosis is frequently made late in the pathological process, and the treatment is mainly supportive and infant delivery. It cannot be prevented. Whether cervical ripening and labor induction are risk factors is controversial. A 31-year-old woman who was undergoing cervical ripening and induction of labor at 38 weeks gestation for medication-controlled gestational diabetes (A2GDM) was admitted for delivery. She received five doses of 25 µg vaginal misoprostol serially and, ultimately, a Foley catheter cervical balloon. After approximately 24 hours, she had the sudden onset of unexpected persistent fetal bradycardia. Her cervix was 4 cm at the time of the fetal distress. When she arrived in the operating room, she was hypoxic and difficult to awaken. An emergency cesarean delivery was performed under general endotracheal anesthesia. Immediately after the delivery of a profoundly depressed and acidotic infant with an umbilical cord pH of 6.84, she became hypotensive, requiring vasopressors. After diffuse intravascular coagulation was diagnosed, treatment for AFE was implemented. AFE has a high mortality rate, and the length of time needed to identify the condition and the availability of specialty resources are two elements that can affect the outcome. Newer alternative treatments, such as the supportive "A-OK" (atropine, ondansetron, and ketorolac administration) protocol for AFE, are discussed. Ultimately, both mother and baby survived and, at the six-month check, are doing well with no sequelae.
羊水栓塞（AFE）是一种罕见的病症，可对母婴造成灾难性后果。它可导致迅速的多系统功能衰竭，是孕产妇死亡的重要原因之一。诊断往往在病理过程后期才能做出，治疗主要是支持性治疗和娩出胎儿，无法预防。宫颈成熟和引产是否为危险因素存在争议。一名31岁的女性因药物控制的妊娠期糖尿病（A2GDM）在妊娠38周时接受宫颈成熟和引产入院分娩。她先后接受了5剂25微克的阴道米索前列醇，最终使用了弗利导尿管宫颈球囊。大约24小时后，她突然出现意外的持续性胎儿心动过缓。胎儿窘迫发生时，她的宫颈口已扩张至4厘米。当她被送往手术室时，已出现缺氧且难以唤醒。在全身气管内麻醉下进行了紧急剖宫产。娩出一名严重窒息且酸中毒的婴儿，脐带血pH值为6.84后，她立即出现低血压，需要使用血管加压药。在诊断为弥散性血管内凝血后，开始对羊水栓塞进行治疗。羊水栓塞死亡率很高，识别病情所需的时间以及专科资源的可及性是影响预后的两个因素。文中讨论了羊水栓塞的新型替代治疗方法，如支持性的“A-OK”（使用阿托品、昂丹司琼和酮咯酸）方案。最终，母婴均存活，在六个月的检查中情况良好，无后遗症。
