Amniotic fluid embolism followed by cardiac arrest- A case report and review of the literature

doi:10.3877/cma.j.issn.2095-3259.2020.01.009

Abstract

Abstract:

Objective

To explore the clinical features, diagnosis, treatment and the outcome of amniotic fluid embolism (AFE).

Methods

We retrospectivly studied the clinical manifestation, diagnosis, treatment and the outcome of 1 case of AFE in Peking University Shenzhen Hospital and previous 61 literature reports.

Results

We reported a case of AFE followed by cardiac arrest in a 39 years old woman who was admitted to the hospital with premature rupture of membranes at 39 weeks of gestation. Cardiopulmonary resuscitation and cesarean were performed immediately. The patient and the infant were healthy. The common aura symptoms of patients with AFE included polypnea (27 cases, 44.3%), cyanosis (14 cases, 21.3%), drop of blood pressure (11 cases, 18.0%), altered mental status (9 cases, 14.8%) and dysphoria (8 cases, 13.1%). The common clinical manifestations were circulatory dysfunction (52 cases, 85.2%), respiratory dysfunction (47 cases, 77.0%) and blood dysfunction (39 cases, 63.9%). Eight cases (13.1%) used extracorporeal membrane oxygenation (ECMO), and the prognosis was excellent. Of the 61 patients with AFE, 16 cases (26.2%) died and 45 cases (73.8%) survived. There are 35 cases described neonatal outcome, 24 cases(57.4%)were healthy, 4 cases (6.6%) were dead, 7 cases (11.5%) were transferred to the neonatal intensive care unit (NICU) and the outcome was unknown.

Conclusions

The main manifestations of AFE are circulatory failure, respiratory failure and coagulation failure. Early identification, high quality cardiopulmonary resuscitation and opportune termination of pregnancy are the main treatment methods.

Key words: Amniotic fluid embolism, Pregnancy complications, Cardiac arrest

Ningning Cheng, Yiheng Liang, Shangrong Fan, Shaomei Yan. Amniotic fluid embolism followed by cardiac arrest- A case report and review of the literature[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2020, 09(01): 36-43.

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Figures/Tables 5

References 75

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项目	参考范围	入院	手术中^**	转入ICU	术后第1天	术后第2天	术后第3天
白细胞(×10⁹/L)	3.5～9.5	7.9	19.11	15.85	15.82	13.57	12.94
红细胞(×10¹²/L)	3.8～5.1	4.3	2.53	3.72	2.94	2.56	2.89
血红蛋白(g/L)	115～150	132	80	109	91	79	87
红细胞比积(%)	35～45	38.8	23.2	31.7	24.7	22.3	25.9
血小板(×10⁹/L)	125～350	182	47	140	49	57	104
纤维蛋白原(g/L)	4～6	4.54	1.36	1.61	3.42	－	3.42
纤维蛋白(原)降解产物(mg/L)	0～5	－	>159	42.44	>150	－	－
D-二聚体(mg/L)	0～0.5	－	>20	>20	>20	－	10.28
C反应蛋白(mg/L)	<10	12.2	－	23.72	－	－	－
降钙素原(ng/mL)	<0.05	－	－	16.33	19.54	9.16	5.96
血肌酐(umol/L)	46～92	55	－	83	87	－	－
总胆红素(umol/L)	8.5～29.2	0.9	－	69.3	22.5	14.5	16.4
丙氨酸氨基转移酶(U/L)	9～66	10	－	218	138	102	83
乳酸脱氢酶(U/L)	313～618	－	－	3272	－	－	－
肌酸激酶(U/L)	30～170	－	－	564	－	－	－
肌红蛋白(ng/ml)	0～61.5	－	－	－	267.4	116.1	84.9
乳酸(mmol/L)	0.7～2.1	－	－	4.7	2.98	1.22	0.93
血清补体3(g/L)	0.7～1.4	－	－	0.63	－	－	－
血清补体4(g/L)	0.1～0.4	－	－	0.04	－	－	－
肌钙蛋白(ng/ml)	0～0.034	－	－	14.000	－	－	－
高灵敏度肌钙蛋白(ng/ml)	<0.014	－	－	2.270	－	－	－

项目	参考范围	入院	手术中^**	转入ICU	术后第1天	术后第2天	术后第3天
白细胞(×10⁹/L)	3.5～9.5	7.9	19.11	15.85	15.82	13.57	12.94
红细胞(×10¹²/L)	3.8～5.1	4.3	2.53	3.72	2.94	2.56	2.89
血红蛋白(g/L)	115～150	132	80	109	91	79	87
红细胞比积(%)	35～45	38.8	23.2	31.7	24.7	22.3	25.9
血小板(×10⁹/L)	125～350	182	47	140	49	57	104
纤维蛋白原(g/L)	4～6	4.54	1.36	1.61	3.42	－	3.42
纤维蛋白(原)降解产物(mg/L)	0～5	－	>159	42.44	>150	－	－
D-二聚体(mg/L)	0～0.5	－	>20	>20	>20	－	10.28
C反应蛋白(mg/L)	<10	12.2	－	23.72	－	－	－
降钙素原(ng/mL)	<0.05	－	－	16.33	19.54	9.16	5.96
血肌酐(umol/L)	46～92	55	－	83	87	－	－
总胆红素(umol/L)	8.5～29.2	0.9	－	69.3	22.5	14.5	16.4
丙氨酸氨基转移酶(U/L)	9～66	10	－	218	138	102	83
乳酸脱氢酶(U/L)	313～618	－	－	3272	－	－	－
肌酸激酶(U/L)	30～170	－	－	564	－	－	－
肌红蛋白(ng/ml)	0～61.5	－	－	－	267.4	116.1	84.9
乳酸(mmol/L)	0.7～2.1	－	－	4.7	2.98	1.22	0.93
血清补体3(g/L)	0.7～1.4	－	－	0.63	－	－	－
血清补体4(g/L)	0.1～0.4	－	－	0.04	－	－	－
肌钙蛋白(ng/ml)	0～0.034	－	－	14.000	－	－	－
高灵敏度肌钙蛋白(ng/ml)	<0.014	－	－	2.270	－	－	－

临床表现	例(%)
循环功能障碍	52(85.2%)
呼吸功能障碍	47(77.0%)
血液功能障碍	39(63.9%)
神经功能障碍	28(45.9%)
肾功能障碍	5(8.2%)
肝功能障碍	1(1.6%)

临床表现	例(%)
循环功能障碍	52(85.2%)
呼吸功能障碍	47(77.0%)
血液功能障碍	39(63.9%)
神经功能障碍	28(45.9%)
肾功能障碍	5(8.2%)
肝功能障碍	1(1.6%)

文献	年代(年)	年龄(岁)	孕周(周)	孕产次	发生时间	临床特征	超声心动图	孕产妇结局	后遗症	住院天数(d)	新生儿情况
Seong等^[22]	2018	32	39^＋1	G2P1	阴道产时	血压下降，抽搐，呼吸心跳骤停，DIC	左心室严重收缩功能障碍	存活	无	13	－
Tincrès等^[23]	2017	35	39	G1P0	分娩前	意识丧失，DIC，心脏骤停，ARDS，	急性肺心病	存活	无	39	－
Mita等^[25]	2017	29	37	G4P1	剖宫产时	粉红色泡沫痰，室颤，持续低血压	前间隔运动减退，右心房和右心室增大	存活	无	142	－
Fang等^[28]	2016	35	36	－	剖宫产时	反应迟钝，发绀，心脏停搏，室颤	右心室严重扩张和运动减退	存活	无	13	－
Wise等^[29]	2016	34	39^＋4	G1P0	阴道产时	疲倦，低血压，出血，DIC，粉红色泡沫痰，休克，ARDS	右心室轻度扩张运动减退，三尖瓣反流伴重度肺动脉高压	存活	无	18	健康
Hession等^[30]	2016	33	41	G1P0	阴道产时	心脏骤停，DIC	－	存活	无	26	健康
Sanghavi等^[31]	2015	35	－	G1P0	剖宫产后	呼吸衰竭，ARDS	右心室功能异常，平均肺动脉压54 mmHg	存活	无	－	－
Ecker等^[37]	2012	43	36^＋4	G4P1	剖宫产后	血压血氧降低，呼吸暂停，心脏骤停	－	存活	无	13	健康

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