9/28/2023 0 Comments Amniotic fluid embolism pdf![]() A score ≥ 3 being compatible with overt DIC in pregnancy. DIC was diagnosed using the Modified International Society on Thrombosis and Hemostasis scoring system for overt disseminated intravascular coagulation in pregnancy, which uses platelet count, prothrombin time, and fibrinogen level. Briefly, these criteria combine (1) sudden onset of cardiorespiratory arrest or both hypotension and respiratory compromise (2) documentation of overt DIC (3) clinical onset during labor or within 30 min of delivery of the placenta and (4) no fever during labor. Patients who fulfilled the criteria proposed by Clark et al. All consecutive pregnant women who received ECMO during the delivery period were screened. The medical ICUs from Pitie Salpetrière hospital, Paris, and the University hospital of Nancy, France are among the largest ECMO centers in France with more than 100 ECMO cases per year. This study included patients with AFE rescued by VA-ECMO hospitalized in two university tertiary medical centers between August 2008 and February 2021. To date, data available on this specific population rescued by VA-ECMO were mainly described in single-case reports and concerns can be raised about the increased bleeding risks with ECMO in that context. However, the rarity of the condition, and the difficulties to diagnose AFE, make it particularly challenging to study. Because the cardiopulmonary dysfunction associated with AFE is typically self-limited, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support has been reported in severe forms. Sudden onset of cardiovascular collapse, cardiac arrest, acute respiratory failure, and fulminant disseminated intravascular coagulopathy (DIC) during delivery are the main clinical signs of the most severe forms. Diagnosis is often performed after the exclusion of other peripartum complications. The pathophysiology of AFE involves disruption of the maternal-placental interface, allowing entry of fetal and amniotic components into the maternal circulation, which induces a massive release of mediators leading to a proinflammatory and procoagulant reaction. With a maternal mortality rate ranging from 11 to 43%, AFE has become one of the main direct causes of maternal death in developed countries. ![]() Future studies should focus on customized, patient-centered, rehabilitation programs that could lead to improved HRQL in this population.Īmniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy, occurring in 1.9–2.5 per 100,000 maternities. In this rare per-delivery complication, our results support the use of VA-ECMO despite intense DIC and ongoing bleeding. However, HRQL was lower than age-matched controls and still profoundly impaired in the role-physical, bodily pain, and general health components after a median of 44 months follow-up. 70% of these patients were alive at hospital discharge despite an extreme pre-ECMO severity and massive blood product transfusion. Pre-ECMO hemodynamic was severely impaired with an inotrope score at 370 (55–1530) μg/kg/min, a severe left ventricular ejection fraction measured at 14 (0–40)%, and lactate at 12 (2–30) mmol/L. Seven patients had a cardiac arrest before ECMO and two were cannulated under cardiopulmonary resuscitation. Among that population, 10 patients with AFE who fulfilled our diagnosis criteria were treated with VA-ECMO. Resultsĭuring that 13-year study period, VA-ECMO was initiated in 54 parturient women in two high ECMO volume centers. ICU survivors were assessed for health-related quality of life (HRQL) in May 2021. Clinical characteristics, critical care management, in-intensive care unit (ICU) complications, and hospital outcomes were collected. This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021. Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device. Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC).
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