![]() Typical or classic form has three phases: phase 1-respiratory and circulatory disorders, phase 2-coagulation disturbances, and phase 3-acute renal failure and acute respiratory distress syndrome (ARDS) leading to cardiopulmonary collapse. The associated risk factors for AFE are age more than 35 years, multiparity, cesarean section, instrumental delivery, antepartum hemorrhage, eclampsia, labor induction, fetal distress, fetal death, and male baby.įew authors have proposed two clinical forms of AFE: typical and atypical. She did not have postpartum hemorrhage, and she was not anemic prior to delivery, which helped to rule out hemorrhagic shock. She did not have a history of fever, and the investigation report also supported to rule out sepsis. In this case, the patient had no history of high blood pressure and she was always normotensive. The causes of maternal collapse could be due to hemorrhagic shock, pulmonary embolism, anaphylaxis, septic shock, and aortic dissection.ĭiagnosis is based upon the signs and symptoms observed during the birth or procedure. ![]() ![]() This condition is initiated by entry of amniotic fluid to the bloodstream of the mother, which leads to a serious reaction causing cardiopulmonary arrest and massive coagulopathy.īecause AFE is a diagnosis of exclusion, a precise case definition and criteria are difficult to establish and also other causes of maternal collapse should be ruled out. It can develop even after elective abortion, amniocentesis, cesarean delivery, or trauma. This may occur in healthy women during pregnancy, labor, or following delivery. The patient was doing fine at 3rd week of follow‐up after discharge.Īmniotic fluid embolism is a rare complication but has a high fatality rate, characterized by sudden cardiovascular collapse, dyspnea, or respiratory collapse and disseminated intravascular coagulopathy. She was then transferred to ward on 8th day as she was improving clinically and was discharged from hospital on 14th day. Multidisciplinary management of the patient was done in the maternal ICU for 8 days. Echocardiography, D‐dimer, and APTT were normal, whereas electrocardiogram showed sinus tachycardia. Diagnostic pleural fluid tapping was performed, which was suggestive of transudative effusion. A chest X‐ray was done and was suggestive of pleural effusion. The patient was improving after resuscitative measure but developed tachypnea on 4th postpartum day. She was also started with broad‐spectrum antibiotics and low molecular heparin, which was continued for 10 days. However, as she had started passing urine after 8 hours of resuscitative measure, she did not require hemodialysis. Her renal function was deranged and creatinine values worsened in the first 3 days. She was transfused with IV unit of fresh‐frozen plasma, IV units of fresh blood, and I unit of whole blood over 48 hours. Investigation reports were collected, which was suggestive of DIC. The patient had started bleeding and soakage from the episiotomy site hence, adrenaline packing was also done. The patient was started with noradrenaline as she was not maintaining blood pressure, which was continued for 36 hours and stopped gradually. Arterial blood gas analysis showed lactic acidosis with metabolic alkalosis. After 1500 mL of fluid resuscitation, blood pressure was recorded up to 80/40 mm Hg, but there was no urine output. Repeat blood investigations were sent, blood products were arranged, and the patient was shifted to ICU. Resuscitation was started immediately with intravenous fluid and oxygen supplementation. The abdominal and local examination was normal, and there was no evidence of postpartum hemorrhage or ongoing blood loss. The patient was conscious throughout with GCS of 15/15. There was a drop in the blood pressure and became not recordable within a few minutes. Oxygen saturation was up to 92% on room air. ![]() On examination, she was tachycardic and tachypneic with pulse rate of 170 beats per minute and respiratory rate of 24 breaths per minute, respectively. Labor and delivery were uneventful.Īround half an hour of the delivery, she had started having symptoms of hypoxia such as irritability, sweating, and anxiety. She had progressed after 3rd dose of misoprostol and delivered a macerated female weighing 2.9 kg after 12 hours of induction. She was induced with 50 mcg of misoprostol, which was kept per vaginam 4 hourly on 2nd day of admission. Her investigation reports at admission were all normal except increased liver enzyme values. Abdominal examination showed term size fetus in cephalic presentation without cardiac activity, and the patient was not in labor (Bishop score-3). Her vitals were within normal limits, with systolic blood pressure of 110 mm Hg and diastolic blood pressure of 70 mm Hg. She was well‐oriented to time, place, and person. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |