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Case Reports
. 2024 Dec 6;16(12):e75212.
doi: 10.7759/cureus.75212. eCollection 2024 Dec.

Amniotic Fluid Embolism After Cervical Ripening

Madison French  1 , Teresa Bernardes  2 , Christine C Greves  1 , Shannon Shellhammer  1 , Steve Carlan  1
Affiliations
Case Reports

Amniotic Fluid Embolism After Cervical Ripening

Madison French et al. Cureus. .

Abstract

Amniotic fluid embolism (AFE) is a rare condition that can have catastrophic maternal and infant consequences. It can lead to rapid multisystem failure and is responsible for a significant portion of maternal deaths. The diagnosis is frequently made late in the pathological process, and the treatment is mainly supportive and infant delivery. It cannot be prevented. Whether cervical ripening and labor induction are risk factors is controversial. A 31-year-old woman who was undergoing cervical ripening and induction of labor at 38 weeks gestation for medication-controlled gestational diabetes (A2GDM) was admitted for delivery. She received five doses of 25 µg vaginal misoprostol serially and, ultimately, a Foley catheter cervical balloon. After approximately 24 hours, she had the sudden onset of unexpected persistent fetal bradycardia. Her cervix was 4 cm at the time of the fetal distress. When she arrived in the operating room, she was hypoxic and difficult to awaken. An emergency cesarean delivery was performed under general endotracheal anesthesia. Immediately after the delivery of a profoundly depressed and acidotic infant with an umbilical cord pH of 6.84, she became hypotensive, requiring vasopressors. After diffuse intravascular coagulation was diagnosed, treatment for AFE was implemented. AFE has a high mortality rate, and the length of time needed to identify the condition and the availability of specialty resources are two elements that can affect the outcome. Newer alternative treatments, such as the supportive "A-OK" (atropine, ondansetron, and ketorolac administration) protocol for AFE, are discussed. Ultimately, both mother and baby survived and, at the six-month check, are doing well with no sequelae.

Keywords: amniotic fluid embolism pathophysiology; amniotic fluid embolism treatment; cesarean birth; fetal outcome; pre-induction cervical ripening.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT abdomen and pelvis. There is a 9 x 6 cm hematoma (red arrows) superior to the bladder.
CT: computed tomography
See this image and copyright information in PMC

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References

    1. Amniotic fluid embolism incidence, risk factors and outcomes: a review and recommendations. Knight M, Berg C, Brocklehurst P, et al. BMC Pregnancy Childbirth. 2012;12:7. - PMC - PubMed
    1. Anaphylactoid syndrome of pregnancy: a review of the literature with latest management and outcome data. Gilmore DA, Wakim J, Secrest J, Rawson R. http://pubmed.ncbi.nlm.nih.gov/12776640/ AANA J. 2003;71:120–126. - PubMed
    1. Pregnancy-related mortality in the United States, 1998 to 2005. Berg CJ, Callaghan WM, Syverson C, Henderson Z. Obstet Gynecol. 2010;116:1302–1309. - PubMed
    1. Amniotic fluid embolism: update and review. Sultan P, Seligman K, Carvalho B. Curr Opin Anaesthesiol. 2016;29:288–296. - PubMed
    1. Amniotic fluid embolism: diagnosis and management. Pacheco LD, Saade G, Hankins GD, Clark SL. Am J Obstet Gynecol. 2016;215:16–24. - PubMed

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