Survival After Amniotic Fluid Embolism and Extracorporeal Membrane Oxygenation Support
Abstract
Background
Amniotic fluid embolism is a rare potential complication in the peripartum period.
Case Summary
A 27-year-old nulliparous woman presented for elective induction at 41 weeks’ gestation. Due to nonreassuring fetal heart tracing, the patient underwent emergent caesarean section complicated by pulseless electrical activity arrest secondary to suspected amniotic fluid embolism after fetus delivery. Despite return of spontaneous circulation, the patient remained in cardiogenic shock with right ventricular failure. The patient was cannulated for venoarterial extracorporeal membrane oxygenation. After 5 days, she was converted to a right ventricular assist device, with ultimate complete biventricular recovery.
Discussion
The use of multidisciplinary cardiogenic shock team aids in swift escalation of care in patients with refractory shock requiring mechanical circulatory support. It is crucial to initiate cardiogenic shock teams early in a patient’s clinical course.
Take-Home Messages
Amniotic fluid embolism is a known cause of mortality in postpartum women. Severe cases can lead to cardiac arrest. Rapid initiation of mechanical circulatory support can save lives.
History of Presentation
A 27-year-old nulliparous woman presented for an elective induction at 41 weeks’ gestation. Her labor was complicated by failure to progress accompanied by a nonreassuring fetal heart tracing after attempting to deliver at full cervical dilation for 2 hours. An attempt was made at vacuum-assisted delivery without success and prolonged fetal decelerations were noted postattempt. At this juncture, she was taken for an emergent caesarean section which was performed under epidural anesthesia. The fetus was in vertex position and delivered without any difficulty, and the placenta was also delivered intact with manual extraction. Immediately after the closure of fascia, she developed sudden shortness of breath followed by pulseless electrical activity requiring cardiopulmonary resuscitation for 5 minutes with return of spontaneous circulation with persistent cardiogenic shock.