Fatal amniotic fluid embolism: incidence, risk factors and influence on perinatal outcome

Clinical Characteristics of Postpartum Women With Hypoxia: A Retrospective Analysis of 92 Cases

Purpose

Postpartum hypoxia is a significant concern among clinicians due to its association with fatal diseases such as amniotic fluid embolism. This study analyzed the clinical characteristics of patients with different etiologies of postpartum hypoxia.

Patients and Methods

Ninety-two postpartum cases with hypoxia, defined as oxygen saturation (SpO2) < 95% within 48 h postpartum without supplemental oxygen inhalation, and 100 normal gravidas were enrolled. All patients with postpartum hypoxia underwent 24 h vital sign monitoring and relevant examinations, including hematological tests, chest computed tomography (CT) scans, or CT pulmonary angiography, to determine the cause of hypoxia and received appropriate treatments. All patients were followed up for 1 month.

Results

Compared with normal gravidas, the patients with postpartum hypoxia had a higher occurrence rate of complications, including gestational hypertension (26.09% vs 8.00%), eclampsia (20.65% vs 4.00%), and a lower level of albumin (29.09 ± 0.57 vs 32.74 ± 0.94), thus tended to have longer hospitalization days (7.98 ± 0.40 vs 4.90 ± 0.16), with all P < 0.05. In all 92 cases, the most common cause of postpartum hypoxia was partial atelectasis with pleural effusion (65/92), followed by pulmonary edema (18/92), pneumonia (9/92), pulmonary embolism (6/92), and asthma (4/92). Among the five groups, patients with pneumonia had the longest hospital stay, whereas most patients with partial atelectasis accompanied by pleural effusion were asymptomatic. From the 1-month follow-up, all patients had a favorable prognosis with no apparent symptoms. Among those who underwent re-examination (27/92), no apparent imaging abnormalities were detected.

Conclusion

Postpartum hypoxia, which occurs more commonly in patients with gestational hypertension, is often caused by partial atelectasis with pleural effusion or pulmonary edema. The patient's prognosis was generally satisfactory after treatment.

Extracorporeal Membrane Oxygenation in Amniotic Fluid Embolism: A Systematic Review of Case Reports

Amniotic fluid embolism (AFE) is an obstetric complication that can result in acute circulatory failure during and after labor. The effectiveness of extracorporeal membrane oxygenation (ECMO) in AFE patients has not been established, especially in the context of coagulopathy. This review aims to evaluate the efficacy of ECMO support in AFE patients. We conducted a systematic review of case reports following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment was performed using a standardized tool. Out of 141 studies screened, 33 studies included 79 AFE patients. The median age was 34 years, and the median gestational age was 37.5 weeks. The majority of AFE cases occurred during cesarean section delivery (55.2%), followed by labor before fetal delivery (26.7%). Extracorporeal membrane oxygenation configurations included venoarterial ECMO (81.3%) and extracorporeal cardiopulmonary resuscitation (CPR, 10.7%). The maternal survival rate was 72%, with 21.2% experiencing minor neurological sequelae and 5.8% having major neurological sequelae. Rescue ECMO to support circulation has demonstrated both safety and efficacy in managing AFE. We suggest early activation of local or mobile ECMO as soon as an AFE diagnosis is established. Further studies are needed to assess the benefits and implications of early ECMO support in AFE patients.

Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period

(1) Background: A rare and unexpected consequence of childbirth, labor, or the immediate postpartum period is amniotic fluid embolism (AFE). This study aims to identify AFE cases during or immediately after birth from anesthetic management perspectives. Secondary goals include assessing patient clinical features, obstetric care techniques, birth outcomes, and case survival. (2) Methods: A retrospective observational study assessed AFE patients hospitalized in three Romanian clinical institutions from October 2007 to April 2023. Based on the Society of Maternal-Fetal Medicine (SMFM) criteria, we diagnosed 11 AFE patients. (3) Results: AFE occurred in eight cases (73%) during peripartum, two (18%) within 30 min after placental delivery, and 1 (9%) during a scheduled cesarean surgery. Only one of six cardiorespiratory arrest patients responded to external cardiac massage, while the other five (83%) needed defibrillation. The patients received, on average, five units of red blood cells, six of fresh frozen plasma, and two of activated platelets. Six patients (55%) received factor VIIa infusions. Maternal mortality was 36.3%. Six neonates (75%) needed neonatal resuscitation, and two (25%) died on the second and third days. (4) Conclusions: AFE management necessitates a multidisciplinary approach and the incorporation of advanced life support techniques to optimize outcomes for both the mother and newborn.

A case of sudden multiple hematomas during cesarean section due to amniotic fluid embolism

INTRODUCTION

We report a case of multiple hematomas, a rare manifestation of amniotic fluid embolism (AFE), during cesarean section.

PRESENTATION OF CASE

The patient had a history of pregnancy and cesarean section birth due to placental abruption. At 38 weeks and 2 days, her membrane ruptured, and an emergency cesarean section was performed. During uterine suturing, hematomas suddenly formed in multiple locations, and bleeding began. Intraoperative blood tests revealed decreased hemoglobin and fibrinogen levels, leading to the administration of red blood cells and fresh frozen plasma. Despite initial transfusions, hemoglobin and fibrinogen levels did not increase, necessitating additional transfusions, which ultimately improved the hemoglobin and fibrinogen levels. A post-discharge blood draw showed decreased C3 levels, supporting a diagnosis of disseminated intravascular coagulation (DIC)-type AFE.

DISCUSSION

The sudden onset of hematomas in multiple locations other than the uterine incision wound was an atypical presentation of AFE in this case. The multiple hematomas were caused by DIC-induced hemostasis, and the decreased C3 level in the blood test supported the diagnosis of DIC-type AFE.

CONCLUSION

Multiple hematomas may occur as a symptom of DIC-type AFE and require attention.