[Amniotic fluid embolism during caesarean section].
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Continuous arteriovenous hemofiltration (CAVH) was successfully used in a 35-year-old woman, who had developed amniotic fluid embolism in the course of a premature labor and cesarean delivery. With CAVH, the pulmonary artery pressure decreased, the cardiac index rose, and the arterial oxygenation improved dramatically. This technique seems to be an important contribution to the management of amniotic fluid embolism.
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From 1972 to 1975, four women have died in the United States from documented amniotic fluid embolism during legal induced abortion. These women, whose pregnancies ranged from 14 to 35 menstrual weeks, had intra-amniotic saline instillation (three cases) and hystereotomy (one case). Performance of abortion in the first trimester and use of curettage technics could minimize the risks of this catastrophe.
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This case report illustrates the successful use of activated recombinant factor VIIa in the management of severe postpartum hemorrhage secondary to amniotic fluid embolism.
A case of a 40-year-old female who died of amniotic fluid embolism is presented. This case showed typical histological findings of this syndrome. Postmortem serum of this case showed an elevated tryptase level (67.2ng/ml, normal levels <10ng/ml). Tryptase is a neutral protease of mast cells, and an important indicator of mast cell activation and degranulation. Thus, mast cell activation, a central feature of anaphylaxis, may have been involved in the pathogenetic mechanism of this case.
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