Title : Amniotic fluid embolism case series and literature review
Abstract:
Background: Amniotic fluid embolism (AFE) is a rare but potentially catastrophic complication of pregnancy. It is characterized by acute cardiovascular collapse, altered mental status, and disseminated intravascular coagulation (DIC) occurring during the peripartum period. Although the incidence is low, is it still one of the leading causes of maternal mortality in developed countries. Early recognition of AFE is critical to a successful outcome. Due to the rarity of this condition, most physicians and institutions have limited experience with the management of amniotic fluid embolism. The aim of this study is to (1) report outcomes of patients with AFE in our centre, (2) describe their critical care management and complications, and (3) review the literature on current AFE management.
Methods: This is a 10-year retrospective case series on women with AFE from 2014 to 2023 at Singapore General Hospital identified by Clark’s criteria. Data on patient characteristics, antenatal factors, medical comorbidities, clinical symptoms and signs, treatment, complications and maternal and neonatal outcomes were collected and analysed. Data on clinical characteristics, treatment, complications and outcomes were collected and analysed. A literature review was performed on diagnosis, management, treatment options and outcomes of AFE.
Results: Four cases of AFE were identified. Two met Clark’s criteria and presented with cardiac arrest requiring extracorporeal membrane oxygenation, of which one had cognitive and functional impairment. Two patients had atypical AFE, one with disseminated intravascular coagulation (DIC)-type AFE who did not survive, and another who had paradoxical intracranial emboli from a patent foramen ovale, who had a full recovery. All had coagulopathy and postpartum haemorrhage. Other complications included end-organ damage and nosocomial infections. Early recognition and initiation of cardiovascular support is crucial in AFE. The management of AFE is primarily resuscitative and directed towards the maintenance of oxygenation, cardiac output and blood pressure, and aggressive correction of the coagulopathy.
Conclusion: With prompt recognition and treatment of AFE involving a multidisciplinary team, survival and good outcomes are possible.
