Friday, May 25, 2012

Case Study: Amniotic Fluid Embolism, Dr. Cartier

Cameron Cartier, DO

Case Scenario: Amniotic Fluid Embolism
Bruno Riou, MD, Ph D
Anesthesiology, January 2012 issue
          Amniotic fluid embolism is a rare condition found in the time period immediately prior, during and shortly after deliver which can have catastrophic consequences. This condition is very difficult to diagnose in the early stages and we do not currently have a precise pathophysiology cause to this condition, although it is thought to be partly immune mediated or anaphylactic in nature.  The diagnosis remains a diagnosis of exclusion, but should be considered in any peripartum patient that presents with any combination of acute hemodynamic collapse, respiratory distress/hypoxia, DIC and/or mental status change without any other medical explanation.
          Some early signs and symptoms include: acute dyspnea and/or cyanosis, sudden tachycardia, hypotension, acute agitation/ALOC, seizure, coagulopathy, sudden desaturation, loss of EtCO2, ST changes and fetal distress.
          The managemnt of this condition relies on early suspicion and early aggressive hemodynamic support. The main therapies include oxygenation, circulatory support and correction of coagulopathy. Immediate Cesarian section improves neonatal neurological recovery and overall maternal outcome.

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