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We report a case of an amniotic fluid embolism (AFE) causing a cardiorespiratory arrest associated temporally with ingestion of castor oil in a full-term normal pregnancy. Risk factors usually associated with AFE were not found in this patient.
A case of amniotic fluid embolus is described with an acute onset occurring 90 min after surgical delivery in a mildly pre-eclamptic primigravida undergoing Caesarean section for a breech presentation. Severe disseminated intravascular coagulation and massive postpartum haemorrhage were corrected and she went on to make a full recovery. The pathophysiology of amniotic fluid embolism is discussed and new diagnostic tests are reviewed. It is suggested that in this patient an amniotic fluid collection in dilated uterine veins was mobilised as venous tone returned following the offset of spinal anaesthesia and sympathetic blockade.
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Three patients showing the typical features of amniotic fluid embolism are described. Two survived the insult, while in the third the diagnosis was confirmed by post-mortem histological examination of the lungs.
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STUDY DESIGN AND SETTING: Two case reports, University Hospital of Antwerp, tertiary referral hospital of the University of Antwerp, Edegem, Belgium. METHODS AND RESULTS: Two women were transferred to our hospital because of acute cardiorespiratory failure due to amniotic fluid embolism during the peripartal period. Both required intensive supportive treatment and invasive monitoring. Haemodynamic data revealed primary left ventricular failure confirming the clinical picture of cardiogenic pulmonary oedema. Review of the literature provides data that do not support obstruction of the pulmonary vasculature by amniotic fluid as the only primary pathophysiological event. However, despite several case reports stressing left ventricular failure as the dominant clinical event, pathophysiological mechanisms are merely speculative. CONCLUSIONS: The diagnosis of amniotic fluid embolism remains a clinical challenge, but can be supported by the presence of amniotic cells in the pulmonary artery, aspirated through a pulmonary artery catheter. The treatment is still not causative but supportive. An overview of cases in the literature with predominant left heart failure during amniotic fluid embolism is given.