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Amniotic fluid embolism-associated coagulopathy: a single-center observational study

  • Maternal-Fetal Medicine
  • Published:
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Abstract

Introduction

Amniotic fluid embolism (AFE) continues to be a rare, enigmatic condition with high maternal mortality. It is characterized by cardiovascular compromise, loss of consciousness or other neurologic symptoms, and coagulopathy. The latter is usually treated according to existing protocols for consumptive coagulopathy.

Methods

Serial analyses of a panel of hemostaseological parameters were performed in three consecutive cases of AFE that occurred at our institution.

Results

All mothers and neonates survived without major sequelae. Disproportionately low levels of fibrinogen and factor five, and exorbitantly elevated d-dimers were present in all cases, whereas markers of consumptive coagulopathy, platelets and antithrombin in particular, were only slightly reduced.

Discussion

Our results support hyperfibrinolysis as contributing factor of AFE-associated coagulopathy. We, therefore, propose a treatment algorithm which includes early use of tranexamic acid and transfusion of red blood cells and fresh frozen plasma, adding fibrinogen if hemostasis is not readily achieved.

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Abbreviations

AF:

Amniotic fluid

AFE:

Amniotic fluid embolism

AT:

Antithrombin

BE:

Base excess

C/S:

Cesarean section

EA:

Endotracheal anesthesia

EBL:

Estimated blood loss

F:

Female

FFP:

Fresh frozen plasma

FHR:

Fetal heart rate

FTNVD:

Full term normal vaginal delivery

FV:

Factor 5

FVII:

Factor 7

FVIII:

Factor 8

G:

Gravida

GA:

Gestational age

GCS:

Glasgow Coma Score

Hb:

Hemoglobin

INR:

International normalized ratio

IoL:

Induction of labor

ISTH:

International Society of Thrombosis and Haemostasis

IVC:

Inferior vena cava

P:

Para

Plt:

Platelet count

Post:

After delivery

PRC:

Packed red cells

Pre-OP:

Before operation

RA:

Regional anesthesia

RBC:

Red blood cells

uApH:

Umbilical artery pH

UFH/LMWH:

Unfractioned heparin/low-molecular weight heparin

VES:

Ventricular extrasystoly

Y:

Year

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany

    Lars Schröder

  2. Department of Obstetrics and Prenatal Medicine, University Bonn Medical School, Bonn, Germany

    Lars Schröder, Astrid Hellmund, Ulrich Gembruch & Waltraut Maria Merz

Authors
  1. Lars Schröder
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  2. Astrid Hellmund
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  3. Ulrich Gembruch
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  4. Waltraut Maria Merz
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Correspondence to Lars Schröder.

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The authors declare that they have no conflict of interest.

Ethical approval

The University Bonn Institutional Review Board does not require formal approval for retrospective observational studies; therefore, ethical approval was not sought.

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Informed consent was obtained from all individual participants included in the study.

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Schröder, L., Hellmund, A., Gembruch, U. et al. Amniotic fluid embolism-associated coagulopathy: a single-center observational study. Arch Gynecol Obstet 301, 923–929 (2020). https://doi.org/10.1007/s00404-020-05466-w

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  • DOI: https://doi.org/10.1007/s00404-020-05466-w

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