![]() ![]() ![]() Ultrasound imaging and computed tomography (CT) revealed a large retrovesical hematoma. The patient’s systolic arterial pressure decreased to 80 mmHg and heart rate (HR) increased to 148 beats/min. ![]() The patient’s trachea was extubated and returned to the obstetrics ward.įour hours after cesarean delivery, vaginal hemorrhage increased rapidly. At 38 weeks and 1 day of gestation, cesarean delivery was performed under general anesthesia without complications. Laboratory findings on admission were as follows: normal electrocardiogram and chest X-ray, hemoglobin 10.7 g/dL, platelet count 32.2 × 10 4/μL, fibrin degradation product (FDP) 6 μg/mL, D-dimer 2.2 μg/mL, fibrinogen 431 mg/dL, no urinary glucose or protein. She was not taking any herbal preparations or anticoagulants. She gave us her history of frequent transient ischemic attacks during hyperventilation associated with moyamoya disease therefore, a cesarean delivery under general anesthesia was planned to avoid ischemic attack during labor. We present a case of AFE with cardiac arrest arising from DIC following elective cesarean delivery.Ī 38-year-old woman (67.3 kg, 160 cm tall, and G3 P2) with moyamoya disease was scheduled for a repeat cesarean delivery. On the basis of this clinical heterogeneity, it was recently suggested that AFE may involve disseminated intravascular coagulation (DIC), uterine atony, and (or) cardiopulmonary collapse. However, AFE has a wide spectrum of manifestations, and patients do not always follow the classic clinical course. The three classic AFE symptoms are acute hypoxia, severe hypotension or cardiac arrest, and coagulopathy, which generally occur suddenly during labor (or pregnancy termination) or shortly after delivery. The risk factors associated with AFE include advanced maternal age, placental abnormalities, operative deliveries, eclampsia, polyhydramnios, cervical lacerations, and uterine rupture. However, AFE has a high mortality of 21.6 % in the United States and 24.3 % in Japan. In the present case of DIC-type AFE, however, early supplementation of clotting factors and platelets was critical for patient survival.Īmniotic fluid embolism (AFE), a severe maternal reaction to amniotic fluid contents entering the circulation, occurs in only 2–8 of every 100,000 deliveries. In cardiopulmonary collapse type AFE, cardiopulmonary resuscitation without delay is important. During surgery, the patient received fresh frozen plasma, platelets, fibrinogen, and antithrombin concentrate. ![]() The patient was successfully resuscitated and a hysterectomy performed. She was transferred to the operating room for emergency laparotomy, but sustained a cardiac arrest. Delivery was uneventful, but massive vaginal bleeding without clotting and ensuing hypovolemic shock occurred 4 h later. The patient was scheduled for elective cesarean delivery because of a previous cesarean section and moyamoya disease. We report a case of DIC-type AFE successfully treated by blood volume replacement and coagulation therapy. Kanayama and colleagues distinguished the cardiopulmonary collapse type (or classic type) from the disseminated intravascular coagulation (DIC) type of AFE on the basis of the presence of uterine atony and DIC in the latter prior to cardiopulmonary failure. The clinical manifestations of AFE are heterogeneous, leading to misdiagnosis or treatment delay. Amniotic fluid embolism (AFE) is a rare but life-threatening maternal emergency caused by the entry of amniotic fluid contents into the maternal circulation. ![]()
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