Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period
Abstract
:1. Introduction
- The abrupt occurrence of cardiorespiratory arrest OR arterial hypotension (systolic blood pressure < 90 mmHg) accompanied by signs of respiratory dysfunction (such as dyspnea, cyanosis, or peripheral oxygen saturation < 90%).
- Recording disseminated intravascular coagulation (DIC) according to the criteria established by the Scientific and Standardization Committee for DIC of the International Society of Thrombosis and Haemostasis (ISTH) [9], adjusted for pregnancy:
- ○
- Platelet count (>100,000/mL = 0 points; <100,000 = 1 point; <50,000 = 2 points).
- ○
- Extended prothrombin time or international normalized ratio (<25% increase = 0 points; 25 to 50% increase = 1 point; >50% increase = 2 points).
- ○
- Fibrinogen level (>200 mg/dL = 0 points; <200 mg/dL = 1 point. A score of ≥3 indicates compatibility with the diagnosis of DIC.
- Clinical onset either during labor or within 30 min of placental expulsion.
- Absence of fever (≥38 °C) during labor.
- Aura—Up to one-third of individuals might encounter abrupt feelings of anxiety, chills, nausea and vomiting, agitation, or alterations in mental state just prior to the event.
- Cardiorespiratory failure and/or arrest—Most patients experience a sudden onset of hypoxemic respiratory failure, hypotension leading to cardiogenic shock, and/or cardiovascular collapse or cardiac arrest. Common clinical indicators comprise reduced oxygen saturation, dyspnea, tachypnea, cyanosis and sometimes wheezing. Cardiac arrest typically arises from sustained pulseless ventricular tachycardia or ventricular fibrillation, although it can also stem from bradyarrhythmia and/or asystole. Should the patient survive the initial cardiorespiratory episode, they frequently develop non-cardiogenic pulmonary edema as the left ventricular failure ameliorates.
- Hemorrhaging—In DIC, bleeding occurs in over 80% of AFE patients, typically manifesting shortly after the onset of cardiorespiratory compromise. In postpartum confinement, extended bleeding from puncture or intervention sites may indicate the onset of DIC.
- Tonic–clonic seizures and/or stroke—These initial presentations are uncommon and less frequently encountered complications of AFE.
2. Patients and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Gist, R.S.; Stafford, I.P.; Leibowitz, A.B.; Beilin, Y. Amniotic fluid embolism. Anesth. Analg. 2009, 108, 1599–1602. [Google Scholar] [CrossRef] [PubMed]
- Clark, S.L. Amniotic fluid embolism. Obstet. Gynecol. 2014, 123, 337–348. [Google Scholar] [CrossRef] [PubMed]
- Mazza, G.R.; Youssefzadeh, A.C.; Klar, M.; Kunze, M.; Matsuzaki, S.; Mandelbaum, R.S.; Ouzounian, J.G.; Matsuo, K. Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism. JAMA Netw. Open 2022, 5, e2242842. [Google Scholar] [CrossRef]
- Pacheco, L.D.; Saade, G.; Hankins, G.D.; Clark, S.L. Amniotic fluid embolism: Diagnosis and management. Am. J. Obstet. Gynecol. 2016, 215, B16–B24. [Google Scholar] [CrossRef]
- Balazic, J.; Rott, T.; Jancigaj, T.; Popović, M.; Zajfert-Slabe, M.; Svigelj, V. Amniotic fluid embolism with involvement of the brain, lungs, adrenal glands, and heart. Int. J. Leg. Med. 2003, 117, 165–169. [Google Scholar] [CrossRef] [PubMed]
- Clark, S.L.; Hankins, G.D.; Dudley, D.A.; Dildy, G.A.; Porter, T.F. Amniotic fluid embolism: Analysis of the national registry. Am. J. Obstet. Gynecol. 1995, 172, 1158–1167; discussion 1159–1167. [Google Scholar] [CrossRef]
- Hikiji, W.; Tamura, N.; Shigeta, A.; Kanayama, N.; Fukunaga, T. Fatal amniotic fluid embolism with typical pathohistological, histochemical and clinical features. Forensic Sci. Int. 2013, 226, e16–e19. [Google Scholar] [CrossRef]
- Wu, H.D.; Song, Z.K.; Cao, H.Y.; Xu, X.Y.; Tang, M.L.; Yang, S.; Liu, Y.; Qin, L. Successful treatment of amniotic fluid embolism complicated by disseminated intravascular coagulation with rivaroxaban: A case report. Medicine 2020, 99, e18951. [Google Scholar] [CrossRef] [PubMed]
- Toh, C.H.; Hoots, W.K. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: A 5-year overview. J. Thromb. Haemost. 2007, 5, 604–606. [Google Scholar] [CrossRef]
- Morgan, M. Amniotic fluid embolism. Anaesthesia 1979, 34, 20–32. [Google Scholar] [CrossRef]
- Kaur, K.; Bhardwaj, M.; Kumar, P.; Singhal, S.; Singh, T.; Hooda, S. Amniotic fluid embolism. J. Anaesthesiol. Clin. Pharmacol. 2016, 32, 153–159. [Google Scholar] [CrossRef] [PubMed]
- Cheung, A.N.; Luk, S.C. The importance of extensive sampling and examination of cervix in suspected cases of amniotic fluid embolism. Arch. Gynecol. Obstet. 1994, 255, 101–105. [Google Scholar] [CrossRef]
- Roberts, C.L.; Algert, C.S.; Knight, M.; Morris, J.M. Amniotic fluid embolism in an Australian population-based cohort. BJOG 2010, 117, 1417–1421. [Google Scholar] [CrossRef]
- Abenhaim, H.A.; Azoulay, L.; Kramer, M.S.; Leduc, L. Incidence and risk factors of amniotic fluid embolisms: A population-based study on 3 million births in the United States. Am. J. Obstet. Gynecol. 2008, 199, 49.e1–49.e8. [Google Scholar] [CrossRef]
- Kramer, M.S.; Rouleau, J.; Baskett, T.F.; Joseph, K.S. Amniotic-fluid embolism and medical induction of labour: A retrospective, population-based cohort study. Lancet 2006, 368, 1444–1448. [Google Scholar] [CrossRef] [PubMed]
- Conde-Agudelo, A.; Romero, R. Amniotic fluid embolism: An evidence-based review. Am. J. Obstet. Gynecol. 2009, 201, 445.e1–445.e13. [Google Scholar] [CrossRef]
- Dennis, A.T.; Solnordal, C.B. Acute pulmonary oedema in pregnant women. Anaesthesia 2012, 67, 646–659. [Google Scholar] [CrossRef] [PubMed]
- Tuffnell, D.J. United kingdom amniotic fluid embolism register. BJOG 2005, 112, 1625–1629. [Google Scholar] [CrossRef]
- Lim, C.; Tsung-Che Hsieh, C.; Lai, S.Y.; Chu, Y.-T.; Chen, M.; Wu, H.-H. Amniotic fluid embolism: A case report of good outcome with timely intensive multidisciplinary team involvement. Taiwan. J. Obstet. Gynecol. 2023, 62, 921–924. [Google Scholar] [CrossRef]
- Ihara, K.; Naito, S.; Okado, T.; Rai, T.; Mori, Y.; Toda, T.; Uchida, S.; Sasaki, S.; Matsui, N. Successful recovery from an acute kidney injury due to amniotic fluid embolism. Intern. Med. 2015, 54, 49–54. [Google Scholar] [CrossRef]
- Huang, C.; Chen, S. Acute kidney injury during pregnancy and puerperium: A retrospective study in a single center. BMC Nephrol. 2017, 18, 146. [Google Scholar] [CrossRef] [PubMed]
- Zhu, C.; Xu, D.; Luo, Q. Fatal amniotic fluid embolism: Incidence, risk factors and influence on perinatal outcome. Arch. Gynecol. Obstet. 2023, 307, 1187–1194. [Google Scholar] [CrossRef] [PubMed]
- Wiseman, D.; Simard, C.; Yang, S.S.; Koolian, M.; Abenhaim, H.A.; Lipes, J. Echocardiography findings in amniotic fluid embolism: A systematic review of the literature. Can. J. Anesth. J. Can. D’anesthésie 2023, 70, 151–160. [Google Scholar] [CrossRef] [PubMed]
- Serbanescu, L.; Badiu, D.; Popescu, S.; Busu, D.; Costea, A.C. The management of tubo-ovarian abscesses associated with appendicitis. J. Mind Med. Sci. 2021, 8, 16. [Google Scholar] [CrossRef]
- Ponzio-Klijanienko, A.; Vincent-Rohfritsch, A.; Girault, A.; Le Ray, C.; Goffinet, F.; Bonnet, M.P. Evaluation of the 4 diagnosis criteria proposed by the SMFM and the AFE foundation for amniotic fluid embolism in a monocentric population. J. Gynecol. Obstet. Hum. Reprod. 2020, 49, 101821. [Google Scholar] [CrossRef] [PubMed]
- Gilbert, W.M.; Danielsen, B. Amniotic Fluid Embolism: Decreased Mortality in a Population-Based Study. Obstet. Gynecol. 1999, 93, 973–977. [Google Scholar] [CrossRef] [PubMed]
- Rath, W.H.; Hoferr, S.; Sinicina, I. Amniotic fluid embolism: An interdisciplinary challenge: Epidemiology, diagnosis and treatment. Dtsch. Arztebl. Int. 2014, 111, 126–132. [Google Scholar] [CrossRef]
- Yoneyama, K.; Sekiguchi, A.; Matsushima, T.; Kawase, R.; Nakai, A.; Asakura, H.; Takeshita, T. Clinical characteristics of amniotic fluid embolism: An experience of 29 years. J. Obstet. Gynaecol. Res. 2014, 40, 1862–1870. [Google Scholar] [CrossRef]
- Clark, S.L.; Cotton, D.B.; Gonik, B.; Greenspoon, J.; Phelan, J.P. Central hemodynamic alterations in amniotic fluid embolism. Am. J. Obstet. Gynecol. 1988, 158, 1124–1126. [Google Scholar] [CrossRef]
- Brown, M.; Hong, M., Jr.; Lindquist, J. Uterine Artery Embolization for Primary Postpartum Hemorrhage. Tech. Vasc. Interv. Radiol. 2021, 24, 100727. [Google Scholar] [CrossRef]
- Balki, M.; Wong, C.A. Refractory uterine atony: Still a problem after all these years. Int. J. Obstet. Anesth. 2021, 48, 103207. [Google Scholar] [CrossRef] [PubMed]
- Kim, M.J.; Kim, I.J.; Kim, S.; Park, I.Y. Postpartum hemorrhage with uterine artery embolization: The risk of complications of uterine artery embolization. Minim. Invasive Ther. Allied Technol. 2022, 31, 276–283. [Google Scholar] [CrossRef] [PubMed]
- Uszyński, M.; Uszyński, W. Coagulation and fibrinolysis in amniotic fluid: Physiology and observations on amniotic fluid embolism, preterm fetal membrane rupture, and pre-eclampsia. Semin. Thromb. Hemost. 2011, 37, 165–174. [Google Scholar] [CrossRef]
- Skolnik, S.; Ioscovich, A.; Eidelman, L.A.; Davis, A.; Shmueli, A.; Aviram, A.; Orbach-Zinger, S. Anesthetic management of amniotic fluid embolism—A multi-center, retrospective, cohort study. J. Matern. Fetal Neonatal Med. 2019, 32, 1262–1266. [Google Scholar] [CrossRef] [PubMed]
- Spiliopoulos, M.; Puri, I.; Jain, N.J.; Kruse, L.; Mastrogiannis, D.; Dandolu, V. Amniotic fluid embolism-risk factors, maternal and neonatal outcomes. J. Matern. Fetal Neonatal Med. 2009, 22, 439–444. [Google Scholar] [CrossRef]
- Han, Y.; Wang, S.; Li, Z.; Zhang, H.; Zheng, Y.; Wang, Z.; Xie, L. An investigation of the risk factors, an analysis of the cause of death, and the prevention strategies for amniotic fluid embolism. Int. J. Clin. Exp. Med. 2020, 13, 5114–5121. [Google Scholar]
- Matsuda, Y.; Kamitomo, M. Amniotic fluid embolism: A comparison between patients who survived and those who died. J. Int. Med. Res. 2009, 37, 1515–1521. [Google Scholar] [CrossRef]
- Oda, T.; Tamura, N.; Ide, R.; Itoh, T.; Horikoshi, Y.; Matsumoto, M.; Narumi, M.; Kohmura-Kobayashi, Y.; Furuta-Isomura, N.; Yaguchi, C.; et al. Consumptive Coagulopathy Involving Amniotic Fluid Embolism: The Importance of Earlier Assessments for Interventions in Critical Care. Crit. Care Med. 2020, 48, e1251–e1259. [Google Scholar] [CrossRef] [PubMed]
- Dedhia, J.D.; Mushambi, M.C. Amniotic fluid embolism. Contin. Educ. Anaesth. Crit. Care Pain 2007, 7, 152–156. [Google Scholar] [CrossRef]
- Furuta, N.; Yaguchi, C.; Itoh, H.; Morishima, Y.; Tamura, N.; Kato, M.; Uchida, T.; Suzuki, K.; Sugihara, K.; Kawabata, Y.; et al. Immunohistochemical detection of meconium in the fetal membrane, placenta and umbilical cord. Placenta 2012, 33, 24–30. [Google Scholar] [CrossRef]
- Oi, H.; Naruse, K.; Koike, N.; Tsunemi, T.; Shigetomi, H.; Kanayama, N.; Kobayashi, H. Predictor of mortality in patients with amniotic fluid embolism. J. Obstet. Gynaecol. Res. 2014, 40, 941–945. [Google Scholar] [CrossRef] [PubMed]
- Balinger, K.J.; Chu Lam, M.T.; Hon, H.H.; Stawicki, S.P.; Anasti, J.N. Amniotic fluid embolism: Despite progress, challenges remain. Curr. Opin. Obstet. Gynecol. 2015, 27, 398–405. [Google Scholar] [CrossRef] [PubMed]
- Young, B.K.; Florine Magdelijns, P.; Chervenak, J.L.; Chan, M. Amniotic fluid embolism: A reappraisal. J. Perinat. Med. 2024, 52, 126–135. [Google Scholar] [CrossRef] [PubMed]
- Melinte-Popescu, A.S.; Popa, R.F.; Harabor, V.; Nechita, A.; Harabor, A.; Adam, A.M.; Vasilache, I.A.; Melinte-Popescu, M.; Vaduva, C.; Socolov, D. Managing Fetal Ovarian Cysts: Clinical Experience with a Rare Disorder. Medicina 2023, 59, 715. [Google Scholar] [CrossRef] [PubMed]
- Stein, P.D.; Matta, F.; Yaekoub, A.Y. Incidence of amniotic fluid embolism: Relation to cesarean section and to age. J. Womens Health 2009, 18, 327–329. [Google Scholar] [CrossRef] [PubMed]
- Knight, M.; Tuffnell, D.; Brocklehurst, P.; Spark, P.; Kurinczuk, J.J. Incidence and risk factors for amniotic-fluid embolism. Obstet. Gynecol. 2010, 115, 910–917. [Google Scholar] [CrossRef]
- Yang, W.; Zhou, N.; Zhou, Y. The clinical analysis of 38 cases with amniotic fluid embolism. Zhonghua Fu Chan Ke Za Zhi 2000, 35, 75–78. [Google Scholar]
Pregnant Women Data | Median and IQR Range/Mean and SD/Number of Patients and % | |
---|---|---|
Demographics | Maternal age, years | 24 (20–31)/24.4 ± 6.2 |
Living Environment | Rural = 7 (63.6%) Urban = 4 (36.6%) | |
Age of AFE diagnosis during pregnancy, weeks | 38 (36 + 2–39 + 5)/38.1 ± 1.3 | |
Clinical parameters | Preeclampsia | Yes = 2 (18.1%) |
IUGR | Yes = 1 (9%) | |
APS | Yes = 1 (9%) | |
Thrombotic antecedents | Yes = 1 (9%) | |
Smoking | Yes = 2 (18.1%) | |
Parity | 1 (1–2)/1.13 ± 0.88 |
Predictor | HR and 95%CI | p Value |
---|---|---|
Artificial rupture of membranes | 2.73 (0.46–7.38) | 0.004 |
Complicated delivery | 2. 32 (0.34–8.61) | 0.001 |
Prolonged prothrombin time | 1.47 (−0.33–5.49) | 0.03 |
Severe thrombocytopenia | 1.12 (−0.77–4.98) | 0.04 |
Low fibrinogen | 0.99 (0.31–2.47) | 0.45 |
Severe desaturation | 0.82 (0.42–1.60) | 0.57 |
Recurrent arrythmias | 1.04 (−0.67–2.88) | 0.78 |
Neonatal Outcomes | Patients Admitted to the NICU or Clinical Ward (n = 11 Patients) |
---|---|
Sex (n/%) | Male = 5 (45.4%) Female = 6 (54.5%) |
Birth weight (g) | 3120 (2340–3600) |
Apgar score at 5 min | 7 (5–8) |
Hospitalization to NICU | Yes = 2 (18.1%) |
Arterial pH | 7.15 (6.71–7.32) |
Neonatal death | Yes = 2 (18.1%) |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Susanu, C.; Harabor, A.; Vicoveanu, P.; Vasilache, I.-A.; Călin, A.-M. Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period. J. Clin. Med. 2024, 13, 2916. https://doi.org/10.3390/jcm13102916
Susanu C, Harabor A, Vicoveanu P, Vasilache I-A, Călin A-M. Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period. Journal of Clinical Medicine. 2024; 13(10):2916. https://doi.org/10.3390/jcm13102916
Chicago/Turabian StyleSusanu, Carolina, Anamaria Harabor, Petronela Vicoveanu, Ingrid-Andrada Vasilache, and Alina-Mihaela Călin. 2024. "Anesthetic Considerations and Outcomes in Amniotic Fluid Embolism: A Retrospective Study over a 15-Year Period" Journal of Clinical Medicine 13, no. 10: 2916. https://doi.org/10.3390/jcm13102916