A Case Report of Amniotic Fluid Embolism - ภาวะน้ำคร่ำอุดตันหลอดเลือดในปอด

Abstract

            A 29-year-old term pregnancy woman presented with 2nd stage of labor. She was healthy but developed immediately cardiopulmonary arrest. The cardiopulmonary resuscitation was done. AFE was diagnosed. Cut down was done on both arms for IV fluid resuscitation and blood transfusion. A male 2,800-gram newborn was delivered by vaccuum extraction. The APGAR score was 4 after birth and then 8 after resuscitation. The newborn was transferred to NICU and treated by a pediatrician. The uterus had a good contraction after delivery but she developed severe postpartum hemorrhage 15 minutes later. Her blood pressure dropped down to 60/20 mmHg, all other causes of postpartum hemorrhage were excluded. Foley’s Catheter Ballooning Temponade technic, massive blood and other blood component transfusion by IV push and supportive treatment were used. Hemorrhage stopped within 8 hours. Total blood loss was 5,100 cc. and total blood transfusion was 16 units. The Foley’s Catheter Ballooning Temponade was off after 24 hours. She had gained conscious on the 3rd day of admission without any acute complications and was discharged with her newborn from the hospital on the 10th day of admission. She was followed up about 6 weeks later and reported to be without Sheehan’s syndrome or any other complications. The final diagnosis of this patient with acute cardiopulmonary arrest, shock, alteration of conscious in 2nd stage of labor and followed by severe disseminated intravascular coagulation was amniotic fluid embolism.

Key words: amniotic fluid embolism, acute cardio-pulmonary failure, shock, alteration of conscious, severe post-partum hemorrhage