A case of a patient who had amniotic fluid embolism during labor but who was successfully resuscitated with severe neurological sequelae

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  • 分娩中に発症して救命しえたが重度の後遺障害を生じた羊水塞栓症の1例
  • 症例報告 分娩中に発症して救命しえたが重度の後遺障害を生じた羊水塞栓症の1例
  • ショウレイ ホウコク ブンベン チュウ ニ ハッショウ シテ キュウメイ シエタ ガ ジュウド ノ ゴイショウガイ オ ショウジタ ヨウスイ ソクセンショウ ノ 1レイ

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Abstract

Amniotic fluid embolism (AFE) is a rare obstetric emergency involving a maternal pulmonary embolism caused by amniotic fluid or fetal cells. AFE has recently been thought of as a process of anaphylaxis occurring when amniotic fluid or fetal debris enters the maternal circulation. We report a case of AFE occurring during labor, leading the patient to suffer cardiac arrest. The patient’s life was eventually saved, but she suffered severe sequelae. A 32-year-old primipara was admitted in labor. The following day the patient’s membranes ruptured before the cervix was fully dilated. Severe variable decelerations were noted during the second phase of labor, so delivery was assisted by pushing on the uterus. The patient delivered a boy, and the amniotic fluid was highly turbid. After delivery, massive bleeding from the uterus continued despite use of oxytocic drugs. Seventy-two minutes after delivery, the patient’s blood pressure had dropped to 50 mmHg and the patient lost consciousness. Noradrenaline was given and blood was transfused. The patient was transferred to the ICU. One hour later, the patient suffered cardiac arrest and she was revived after cardiopulmonary resuscitation. More blood was transfused and anti-DIC drugs were administered, but massive bleeding of 10000g from the uterus and the site of the venous catheter continued until the following morning. We performed surgery to remove the bleeding uterus. After the surgery, bleeding decreased. However, the patient suffered multiple organ failure due to hypovolemic shock, so the patient remained in the ICU for two months. The patient was confined to her bed due to left limb paralysis caused by brain ischemia, and she also had difficulty communicating because of brain damage. These conditions precluded the patient’s return home, and she was transferred to another hospital for rehabilitation after six months from delivery. A blood sample obtained when the patient lost 1600g of blood from her uterus one hour after delivery suggested severe DIC and a high level of sialyl-Tn (STN). Probably DIC is presumed to have occurred after delivery. Pathological findings from the uterus suggested the presence of amniotic fluid in blood vessels of the myometrium. Based on these findings, we concluded this case was amniotic fluid embolism. [Adv Obstet Gynecol, 67 (4) : 381-387, 2015 (H27.10)]

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