Amniotic fluid embolism with different clinical manifestations of uterine hemorrhage: report of three cases and literature review

DOI Web Site
  • MORIUCHI Kaori
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • CHIGUSA Yoshitsugu
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • KONDOH Eiji
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • IO Shingo
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • TANI Hirohiko
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • HAMANISHI Junzo
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
  • MATSUMURA Noriomi
    Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine

Bibliographic Information

Other Title
  • 異なる出血の様相を呈した臨床的羊水塞栓症:3症例の報告と文献的考察
  • 症例報告 異なる出血の様相を呈した臨床的羊水塞栓症 : 3症例の報告と文献的考察
  • ショウレイ ホウコク コトナル シュッケツ ノ ヨウソウ オ テイシタ リンショウテキ ヨウスイ ソクセンショウ : 3 ショウレイ ノ ホウコク ト ブンケンテキ コウサツ

Search this article

Abstract

<p>Amniotic fluid embolism (AFE) is rare, but is one of the most devastating complications of pregnancy, the mortality rate of which is 20 to 60%. Recently, accumulating evidence has indicated that AFE is comprised of two types with different etiologies. One is the cardiopulmonary collapse type AFE which features sudden hypotension and dyspnea. The other is the DIC type AFE, characterized by atonic bleeding and disseminated intravascular coagulation (DIC). Here, we report three cases of AFE that have different clinical course patterns, and discuss the onset timing of AFE based on our literature review. Case 1 was a 27-year-old primigravida, diagnosed as having hypertensive disorders of pregnancy at 35 weeks of gestation. At 38 weeks of gestation, she had eclampsia and vacuum extraction was performed. Just after the delivery, she had an incoagulable hemorrhage, which totaled 14000 ml, and respiratory failure. She died of cerebral hemorrhage. Case 2 was a 34-year-old primigravida. At 41 weeks of gestation, she had a continuous vaginal bleeding and dyspnea during the induction of labor. As soon as an emergency cesarean section was started, a cardiac arrest occurred. Although maternal pulse was restored by percutaneous cardiopulmonary support, the bleeding amounted to 9500 ml and she died of multiple organ failure. Case 3 was a 34-year-old multigravida, and vacuum extraction was carried out because of insufficient progression. After two hours, she suffered cardiac arrest followed by 6400 ml of incoagulable bleeding and respiratory failure. Fortunately, aggressive blood transfusion and intensive resuscitation enabled her to recover without any aftereffects. Our literature review revealed that more than 50% of AFE cases occurred during delivery, but in approximately 10% of AFE cases, the onset timing was more than one hour after delivery. Therefore AFE should be listed in the differential diagnosis at any point of parturition, when the patient has a sudden onset of incoagulable vaginal bleeding with dyspnea. Furthermore, in order to save the mother’s life, it is imperative to transfer the patient to the tertiary emergency medical facility without delay, and to provide the multidisciplinary critical care quickly. [Adv Obstet Gynecol, 69 (4):365-372, 2017 (H29.10)]</p>

Journal

Keywords

Details 詳細情報について

Report a problem

Back to top