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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-07-2016 | Case Reports / Case Series

Amniotic fluid embolism complicating medical termination of pregnancy

Authors: Fatma Medhioub Kaaniche, MD, Anis Chaari, MD, Manel Zekri, MD, Mabrouk Bahloul, MD, Hedi Chelly, MD, Mounir Bouaziz, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 7/2016

Abstract

Background

Amniotic fluid embolism is always a severe complication and generally occurs during labour or immediately after childbirth.

Clinical features

We report the case of a patient falling victim to amniotic fluid embolism after the medical termination of her pregnancy at 24 weeks of amenorrhea following the discovery of a teratoma-carrying foetus. The amniotic fluid embolism diagnosis was strongly suspected in the face of the sudden onset of severe arterial hypotension, hypoxic respiratory distress, a coma state and disseminated intravascular coagulopathy immediately after the delivery. Additional tests were conducted to support the diagnosis: cytological testing of a peripheral venous sample and maternal broncho-alveolar lavage fluid, dosing of tryptase and alpha-fetoprotein levels as well as screening for insulin-like growth factor binding protein 1.

Conclusion

Amniotic fluid embolism is a rare and difficult diagnosis, especially in unconventional settings, yet it can be facilitated by screening for amniotic markers and tryptase.

Bouvier-Colle MH, Philibert M. Epidémiologie de la mortalité maternelle en France, fréquence et caractéristiques. Réanimation 2007; 16: 358-65.CrossRef

Collis R, Plaat F, Urquhart J. Textbook of Obstetric Anaesthesia. Greenwich Medical Media. Cambridge University Press; 2002: 265-83.

Cromey MG, Taylor PJ, Cumming DC. Probable amniotic fluid embolism after first-trimester pregnancy termination. A case report. J Reprod Med 1983; 28: 209-11.PubMed

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.PubMed

Meyer JR. Embolia pulmonar amnio caseosa. Bras Med 1926: 301-3.

Schraub O. Embolie amniotique : une urgence absolue. Revues générales Obstétrique 2013; 170: 27-31.

Spence M, Mason KG. Experimental amniotic fluid embolism in rabbits. Am J Obstet Gynecol 1974; 119: 1073-8.CrossRefPubMed

Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol 1995; 172: 1158-67.CrossRefPubMed

Benson MD. A hypothesis regarding complement activation and amniotic fluid embolism. Med Hypotheses 2007; 68: 1019-25.CrossRefPubMed

10.

Fineschi V, Riezzo I, Cantatore S, Pomara C, Turillazzi E, Neri M. Complement C3a expression and tryptase degranulation as promising histopathological tests for diagnosing fatal amniotic fluid embolism. Virchows Arch 2009; 454: 283-90.CrossRefPubMed

11.

Perdrix C, Gioanni G, Delest A, Constantopoulos P. Embolie de liquide amniotique rapidement fatale. Extraction par césarienne d’un enfant vivant sans séquelles neurologiques. Ann Fr Anesth Reanim 2004; 23: 912-6.CrossRefPubMed

12.

Awad IT, Shorten GD. Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism. Eur J Anaesthesiol 2001; 18: 410-3.CrossRefPubMed

13.

Clark SL. Amniotic fluid embolism. Clin Perinatol 1986; 13: 801-11.PubMed

14.

Davies S. Amniotic fluid embolism and isolated disseminated intravascular coagulation. Can J Anesth 1999; 46: 456-9.CrossRefPubMed

15.

Resnik R, Swartz WH, Plumer MH, Benirschke K, Stratthaus ME. Amniotic fluid embolism with survival. Obstet Gynecol 1976; 47: 295-8.PubMed

16.

Marcus BJ, Collins KA, Harley RA. Ancillary studies in amniotic fluid embolism: a case report and review of the literature. Am J Forensic Med Pathol 2005; 26: 92-5.CrossRefPubMed

17.

Nishio H, Matsui K, Miyazaki T, Tamura A, Iwata M, Suzuki K. A fatal case of amniotic fluid embolism with elevation of serum mast cell tryptase. Forensic Sci Int 2002; 126: 53-6.CrossRefPubMed

18.

Fineschi V, Gambassi R, Gherardi M, Turazilli E. The diagnosis of amniotic fluid embolism: an immunohistochemical study for quantification of pulmonary mast cell tryptase. Int J Legal Med 1998; 111: 238-43.CrossRefPubMed

19.

Adinolfi A, Adinolfi M, Lessof MH. Alpha-feto-protein during development and in disease. J Med Genet 1975; 12: 138-51.CrossRefPubMedPubMedCentral

20.

Rajaram S, Baylink DJ, Mohan S. Insulin-like growth factor-binding proteins in serum and other biological fluids : regulation and functions. Endocr Rev 1997; 18: 801-31.PubMed

21.

Lee PD, Conover CA, Powel DR. Regulation and function of insulin-like growth factor-binding protein-1. Proc Soc Exp Biol Med 1993; 204: 4-29.CrossRefPubMed

22.

Legrand M, Rossignol M, Dreux S, et al. Diagnostic accuracy of insulin-like growth factor binding protein-1 for amniotic fluid embolism. Crit Care Med 2012; 40: 2059-63.CrossRefPubMed

Title: Amniotic fluid embolism complicating medical termination of pregnancy
Authors: Fatma Medhioub Kaaniche, MD
Anis Chaari, MD
Manel Zekri, MD
Mabrouk Bahloul, MD
Hedi Chelly, MD
Mounir Bouaziz, MD
Publication date: 01-07-2016
Publisher: Springer US
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 7/2016
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-016-0618-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Amniotic fluid embolism complicating medical termination of pregnancy

Abstract

Background

Clinical features

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Clinical features

Conclusion

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