Amniotic fluid embolism treated with emergency extracorporeal membrane oxygenation: a case report

Abstract

Background: Amniotic fluid embolism (AFE) is a rare disorder classically characterized by the abrupt onset of hypotension, hypoxia and consumptive coagulopathy during delivery or in the immediate postpartum period. It is postulated that amniotic fluid,fetal cells, hair or other debris enters the maternal circulation, causing cardiopulmonary collapse. The precise pathophysiologic mechanism remains elusive, treatment is supportive, and AFE carries a mortality of up to 80%.

Case: A 21-year-old woman, gravida 2, para 1, at 33+ weeks' gestation with an uncomplicated pregnancy, was admitted with preterm uterine contractions and underwent a low-transverse cesarean section for malpresentation after tocolysis failure. Surgery was without complications; however, 75 minutes postoperatively the patient experienced cardiopulmonary collapse with loss of vital signs. After 20 minutes of cardiopulmonary resuscitation, extracorporeal membrane oxygenation (ECMO) was begun. The patient's status improved rapidly, she was discharged 7 days postoperatively in good condition and remains without sequelae.

Conclusion: Though there is no definitive treatment for AFE, ECMO provided oxygenation and allowed the patient to recover. ECMO may be useful in the treatment of severe cases of AFE.