Abstract
Four probable cases of amniotic fluid embolism (AFE) are reviewed. The outcome appeared to be determined by the severity of the insult, and possibly the gestation of the pregnancy, rather than the management of the AFE. Two cases occurred during early labour; neither patient recovered consciousness. One died two weeks later and the other suffered severe permanent cerebral damage. The other two cases occurred during dilatation and curettage, one for therapeutic abortion at fourteen weeks gestation and the other for missed abortion at twenty weeks gestation. Both patients made full recoveries.
Disseminated intravascular coagulation (DIC) was a feature of all four cases. In the patients in labour it occurred almost immediately. In those undergoing dilatation and curettage it occurred after the patients had apparently recovered but were under observation in the intensive care unit.
Amniotic fluid embolism can occur during an apparently uneventful labour. It should also be suspected when unexplained collapse occurs during second trimester dilatation and curettage. Because severe DIC may follow, such patients should be transferred immediately to a centre with full haemotology services.
Résumé
Quatre cas probable d’embolie de liquide amiotique (AFE) sont revus. Le résultat final est apparamment determiné par la sévérité de l’insulte et possiblement le temps de la grossesse plus que par la conduite thérapeutique. Deux cas sont survenus tot lors du travail; accune patiente n’a retrouve connaissance. Une est décédée une semaine plus tard alors que l’autre a souffert de dommage cérébral permanent sévère. Les deux autres cas sont survenus lors de la dilatation et curetage, une pour avortement thérapeutique a la quatorzième semaine de la gestation et l’autre pour avortement à la vingtième semaine de gestation. Ces deux patientes n’ont accusé aucun dommage après l’accident.
La coagulation intravasculaire disséminée (DIC) était présente pour les quatre cas. Pour les patientes au travail ce syndrome est survenu presqu’immédiatement. Pour celles subissant une dilatation et curetage ce syndrome est survenu après que les patientes se sont rétablies mais étaient en observation aux soins intensifs.
L’embolie de liquide amiotique peut survenir apparemment lors d’un travail sans problème. Elle doit être suspectée lorsqu’un collapsus non expliqué survient lors d’une dilatation et curetage au second trimestre. Parce que une coagulation intravasculaire disséminée peut être provoquée, les patientes doivent être transférées à un centre fournissant des services d’hématologie.
Article PDF
Similar content being viewed by others
References
Shnider SM, Moya F. Amniotic fluid embolism. Anesthesiology 1961; 22:108–19.
Department of Health and Social Security. Report on confidential enquiries into maternal deaths in England and Wales 1976-78; 96-100. London: Her Majesty’s Stationery Office 1982.
Morgan M. Amniotic fluid embolism. Anaesthesia 1979; 34:20–32.
Anderson DG. Amniotic fluid embolism. A reevaluation. Am J Obstet Gynecol 1967; 98:336–48.
Cromey MG, Taylor PJ, Cummings DC. Probable amniotic fluid embolism after first trimester pregnancy termination — a case report. J Reproductive Med 1983; 28:209–11.
Lees DE, Shin Y, MacNamara TE. Probable amniotic fluid embolism during curettage for a missed absorption: a case report. Anesth Analg 1977; 56:739–42.
Lumley J, Owen R, Morgan M. Amniotic fluid embolism. A report of three cases. Anaesthesia 1979; 34:33–6.
Ballas S, Lessing JB, Michowitz M. Amniotic fluid embolism and disseminated intravascular coagulation complicating hypertonic saline-induced absorption. Postgrad Med J 1983; 59:127–9.
Stromme WB, Fromke VL. Amniotic fluid embolism and disseminated intravascular coagulation after evacuation of missed abortion. Obstet Gynec 1978; 52:76s-80s.
Dolyniuk M, Orfei E, Vania H, Karlman R, Tomich P. Rapid diagnosis of amniotic fluid embolism. Obstet Gynecol 1983; 61:28s-30s.
Taenaka N, Shimada Y, Kawai M, Yoshiya I, Kosaki G. Survival from DIC following amniotic fluid embolism. Anaesthesia 1981; 36:389–93.
Schaerf RH, deCampo T, Civetta JM. Hemodynamic alterations and rapid diagnosis in a case of amniotic fluid embolus. Anesthesiology 1977; 46:155–7.
Sterner S, Campbell B, Davies S. Amniotic flud embolism. Ann Emerg Med 1984; 13:343–5.
Grimes DA, Cates W Jr. Fatal amniotic fluid embolism during induced abortion, 1972-1975. South MedJ 1977; 30:1325–6.
Attwood HD. Amniotic fluid embolism. Pathol Annu 1972; 7:145–72.
Masson RG, Rugieri J, Siddiqui MM. Amniotic fluid embolism: definitive diagnosis in a survivor. Am Rev Respir Dis 1979; 120:187–92.
Duff P, Engelsgjerd B, Zingery LW, Hujf RW, Montiel MM. Hemodynamic observations in a patient with intrapartum fluid embolism. Am J Obstet Gynecol 1983; 146:112–5.
Botero SD, Holmquist ND. Cytologic diagnosis of amniotic fluid embolus — report of a case. Acta Cytol (Baltimore) 1979; 23:465–6.
Tuck CS. Amniotic fluid embolus. Proc Royal Soc Med 1972; 65:94–5.
Roche WD, Norris HJ. Detection and significance of maternal amniotic fluid embolism. Obstet Gynecol 1974; 43:729–31.
Garland IWC, Thompson WD. Diagnosis of amniotic fluid embolism using an antiserum to human keratin. J Clin Pathol 1983; 36:625–7.
Mayer JR. Embolis pulmonar-caseosa. Brazil Medico 1926; 2:301–3.
Attwood HD. Matthew Baillie — a possible early description of amniotic fluid embolism. Aust NZ J Obstet Gynaecol 1979; 19:176–7.
Steiner PE, Lushbaugh CC. Maternal pulmonary embolism by amniotic fluid. JAMA 1941; 117:1340–5.
Lewis TLT. Progress in clinical obstetrics and gynecology. 2nd ed. London: Churchill Livingstone 1964, p 48.
Guidotti RJ, Grimes DA, Cates W Jr. Fatal amniotic fluid embolism during legally induced abortion, United States, 1972 to 1978. Am J Obstet Gynecol 1981; 141:257–61.
Cates W Jr,Boyd C, Halvorson-Boyd G, Hoick S, Gilchrist TF. Death from amniotic fluid embolism and disseminated intravascular coagulation after a curettage abortion. Am J Obstet Gynecol 1981; 141:346–8.
Turner R, Gusack M. Massive amniotic fluid embolism. Ann Emerg Med 1984; 13:359–61.
Corridan M, Kendall ED, Begg JD. Cord entanglement causing premature placental separation and amniotic fluid embolism. Br J Obstet Gynecol 1980; 87:935–40.
Plauchi WC. Amniotic fluid embolism (letter to the editor). Am J Obstet Gynecol 1983; 147:982.
Sparr RA, Pritchard JA. Studies to detect the escape of amniotic fluid into the maternal circulation during parturition. Surg Gynecol Obstet 1958; 107:560–4.
Moore PG, James OF, Saltos N. Severe amniotic fluid embolism: case report with hemodynamic findings. Anaesth Intensive Care 1982; 10:40–4.
Barrows JJ. A documented case of amniotic fluid embolism presenting as acute fetal distress. Am J Obstet Gynecol 1982; 143:599–600.
Rodgers GP, Heymach GJ. Cryoprecipitate therapy in amniotic fluid embolization. Am J Med 1984; 76:916–20.
Kern SB, Duff P. Localized amniotic fluid embolism presenting as ovarian vein thrombosis and refractory postoperative fever. Am J Clin Pathol 1981; 76:476–80.
Editorial. Amniotic-fluid embolism. Lancet 1979; 2: 398–400.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mainprize, T.C., Maltby, J.R. Amniotic fluid embolism: A report of four probable cases. Can Anaesth Soc J 33, 382–387 (1986). https://doi.org/10.1007/BF03010754
Issue Date:
DOI: https://doi.org/10.1007/BF03010754