Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound

Nissar Shaikh; Muhammad Fras Alhammad; Seema Nahid; Amara Umm E; Ifrah Fatima; Firdous Ummunnisa; Slawa Abu Yaqoub

doi:10.5339/qmj.2023.13

ISSN: 0253-8253
EISSN: 2227-0426

oa Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound
Authors: Nissar Shaikh¹, Muhammad Fras Alhammad¹, Seema Nahid¹, Amara Umm E², Ifrah Fatima³, Firdous Ummunnisa⁴ and Slawa Abu Yaqoub⁵
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Affiliations: ¹ Department of Anesthesia, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar. E-mail: [email protected] ORCID ID: https://orcid.org/0000-0002-8241-7939 ² Apollo Medical College Hyderabad, Telangana, India ³ The University of Missouri–Kansas City (UMKC), Missouri, USA ⁴ Dr. Halima Al Tamimi, Obstetrics & Gynaecology Centre, Doha, Qatar ⁵ Women’s Wellness & Research Center, Hamad Medical Corporation, Doha, Qatar
Source: Qatar Medical Journal, Volume 2023, Issue 1, May 2023, 13
DOI: https://doi.org/10.5339/qmj.2023.13
- Received: 16 December 2022
- Accepted: 02 April 2023
- Published online: 02 May 2023

Abstract

Introduction: Pregnant patients are at risk of several possible complications during the peripartum period. Amniotic fluid embolism (AFE) is a peripartum complication with high mortality and morbidity. The sudden entry of amniotic fluid into the maternal circulation causes a rapid and dramatic sequence of clinical events called AFE. The reported incidence of AFE after a cesarean section is around 19%, and after a normal delivery, it is 11%. AFE causing multiple embolisms is not reported in the literature, nor is the use of point-of-care ultrasound (POCUS) in the diagnosis of AFE. We report a case of AFE causing pulmonary and ovarian embolisms.

Case: A 34-year-old pregnant lady had an elective lower section cesarean section (LSCS) for transverse lying and placenta previa under combined spinal and epidural anesthesia. She was gravida 3 para 2 and had regular antenatal check-ups, and she presented for her LSCS at 36 weeks of gestation. Immediately after delivery of the fetus, the patient had convulsions, cardiac arrest, and disseminated intravascular coagulopathy (DIC). Immediately, cardiopulmonary resuscitation started, and the team achieved a return of spontaneous circulation (ROSC) in 3 minutes. DIC was corrected with blood and blood products during this maneuver, and POCUS of the inferior vena cava and heart showed multiple small particles floating, thus confirming the diagnosis of AFE in this patient. The patient was transferred to the intensive care unit (ICU), intubated, and ventilated, necessitating a vasopressor infusion. Computed tomographic pulmonary angiography (CTPA) showed pulmonary embolism and ovarian vein embolism, which were managed with heparin infusion. She was hemodynamically stable and weaned from vasopressors, and the ventilator was then extubated on day 13 of ICU admission. She remained awake and in stable condition. The patient was transferred to the ward and subsequently discharged to go home on the 20^th-day post-delivery.

Conclusion: AFE can be quickly diagnosed using clinical manifestations and POCUS, and it can be managed early for better patient outcomes. POCUS will show multiple smaller and a few larger amniotic fluid emboli in the heart and vena cava. These larger AFE emboli can migrate and cause multiple embolisms, requiring systemic anticoagulation.

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/content/journals/10.5339/qmj.2023.13

Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound

Qatar Medical Journal 2023, 13 (2023); https://doi.org/10.5339/qmj.2023.13

/content/journals/10.5339/qmj.2023.13

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Article Type: Case Report

Keyword(s): Amniotic fluid embolism, cardiac arrest, disseminated intravascular coagulopathy, emergency, multiorgan dysfunction, multiple embolisms, peripartum, POCUS and prevention

oa Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound

Abstract

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