We present a similar case of a 26-year-old woman with suspected AFE who was successfully managed with traditional therapy and a novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). have reported “that antiserotonin, antithromboxane, and vagolytic therapy” were the mechanisms for the restoration of a patients’ circulation and led to successful resuscitation. With a greater understanding of the pathophysiology of AFE, new therapies have shown potential. Clark has recently proposed diagnostic criteria for AFE case report in order to prevent over reporting, but the Society for Maternal Fetal Medicine (SMFM) continues to support the current clinical diagnosis. However, as a diagnosis of exclusion, the AFE triad is neither sensitive nor specific and should be considered once other diagnoses have been ruled out. Other symptoms include hypotension, frothing from the mouth, fetal heart rate abnormalities, loss of consciousness, bleeding, uterine atony, and seizure like activity. AFE is traditionally diagnosed clinically, in a woman early during labor with ruptured membranes, by a trio of symptoms: acute respiratory distress, cardiovascular collapse, and coagulopathy. Transesophageal echocardiography (TEE) can be used to determine cardiac dysfunction due to pulmonary hypertension but may not be widely available on obstetric units. This can be a challenge, as AFE is a diagnosis of exclusion with no universal pathological or serological markers. Įarly recognition and initiation of treatment of AFE are essential to increase the likelihood of patient survival. Conde-Agudelo and Romero found the percent total maternal deaths due to AFE to be 13.7%, slightly higher than the previous widely held 10%. AFE is the second leading direct cause of maternal death in the USA and Europe. IntroductionĪmniotic fluid embolism (AFE) is a rare, unpredictable, and potentially devastating complication of childbirth, in which amniotic fluid, fetal cells, hair, or other types of debris enter into the maternal pulmonary circulation, causing cardiovascular collapse. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac. The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. Staff debriefing and psychological support for the woman and family are vital.Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Diagnosis is by exclusion and clinical presentation. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. Obstetric emergencies often require intensive care intervention.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |