Find a Rare Disease Patient Organization.Find Clinical Trials & Research Studies.Launching Registries & Natural History Studies.A Podcast For The Rare Disease Community.Amniotic fluid embolism-associated coagulopathy: A single observational study. Schröder L, Hellmund A, Gembruch U, Merz WM. Society for Maternal-Fetal Medicine special statement: Checklist for initial management of amniotic fluid embolism.
Gina Gardingan a labor and delivery and high-risk antenatal clinical nurse educator. Elizabeth Avis is a rapid response nurse. The authors work at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania. Thompson returned home 39 days after she delivered the baby. Thomson stabilizes overnight, she returns to the OR for an exploratory laparotomy, abdominal washout, and wound vac removal.ĭue to the team’s quick actions, the baby was discharged from the NICU at 9 days and Ms. A repeat TEE reveals a large clot in the inferior vena cava, right atrium, and right ventricle, which the surgeon removes. Her abdomen remains open with a wound vac in place. Thompson stabilizes and is transferred to the surgical intensive care unit (SICU). Neonatal outcome is directly related to maternal collapse. Delivery of the fetus may be indicated to improve maternal cardiac output by releasing a vena cava or aortocaval obstruction. Immediate treatment to optimize hemodynamic function, cardiac output, respiratory support, combined with aggressive management of volume and coagulopathy, enhances maternal outcome. Breech of amniotic fluid occurs in between one and 12 patients for every 100,000 deliveries and is benign in most pregnancies. Some theorize a cascade of events from an emboli blockage in the pulmonary system, whereas others hypothesize a proinflammatory response occurring with the release of cytokines and arachidonic acid metabolites. The terms AFE and anaphylactoid syndrome of pregnancy are used interchangeably due to ongoing debate about the condition’s etiology. Patients experience an anaphylactic-type reaction when the amniotic fluid enters the circulatory system. The altered hemodynamic response associated with classic AFE isn’t completely understood and involves a complex sequence of reactions. When the trauma surgeon reopens her abdominal incision, blood rushes out. The OR nurse notes that the patient’s abdomen is distended. Thompson receives multiple blood products, including fresh frozen plasma, pooled platelets, cryoprecipitate, packed red blood cells, and uncrossed red blood cells. Thompson’s hemoglobin drops to 4 g/L and she develops disseminated intravascular coagulation. The obstetric provider team orders a massive transfusion protocol as Ms. This rare condition occurs where amniotic fluid, fetal cells, tissue, and other debris enter the patient’s bloodstream, resulting in a rapid systemic inflammatory, anaphylactic-like reaction. Thompson is intubated, a stat transesophageal echocardiogram (TEE) reveals fibrinous material in her heart-AFE.
#AMNIOTIC FLUID EMBOLISM TREATMENT CODE#
The OR nurse calls a code blue and initiates CPR.
Thompson continues to decompensate with a pulseless wide complex ventricular tachycardia. Thompson delivers her baby by emergency low-transverse cesarean section in the OR. Suspecting amniotic fluid emboli (AFE), you activate the rapid response team. Thompson’s condition rapidly declines with hypotension, hypoxemia, and unresponsiveness. Fetal heart rate tracing shows a spontaneous uterine hypertonus and terminal bradycardia. Thompson is cyanotic her HR is 154 bpm, respiration rate 38 breaths per minute, blood pressure 60/35 mmHg, and blood oxygen level 82% and steadily declining. When her membranes spontaneously rupture, she experiences an acute change in mental status. Lynn Thompson* is admitted to your unit with gestational hypertension and labor induction.
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