Korean J Crit Care Med.  2016 Aug;31(3):256-261. 10.4266/kjccm.2016.00213.

Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery

Affiliations
  • 1Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
  • 2Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea. okabango21@gmail.com

Abstract

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.

Keyword

amniotic fluid embolism; anaphylaxis; extracorporeal membrane oxygenation

MeSH Terms

Adult
Amniotic Fluid*
Anaphylaxis
Anoxia
Cardiopulmonary Bypass
Cesarean Section
Cognition
Embolism, Amniotic Fluid*
Extracorporeal Membrane Oxygenation*
Female
Humans
Peripartum Period
Pregnancy
Pregnant Women
Pulmonary Circulation
Shock
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