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Obstetrics & Gynecology 2003;102:496-498
© 2003 by The American College of Obstetricians and Gynecologists
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CASE REPORTS

Amniotic Fluid Embolism Causing Catastrophic Pulmonary Vasoconstriction: Diagnosis by Transesophageal Echocardiogram and Treatment by Cardiopulmonary Bypass

Russell D. Stanten, MD, Leigh I. G. Iverson, MD, Terrance M. Daugharty, MD, Stuart M. Lovett, MD, Crystal Terry, MD and Edward Blumenstock, MD

Summit Medical Center, Oakland, California

Address reprint requests to: Stuart Lovett, MD, c/o Mary E. Faulkner, MSN, NP, 350 30th Street, Suite 205, Oakland, CA 94609; E-mail: lovett{at}epbma.com/faulknm@ebpma.com.

ABSTRACT

BACKGROUND: Amniotic fluid embolism is a rare yet often lethal peripartum complication resulting from rapid cardiovascular collapse. Progress toward a better understanding of this entity has failed to identify either the underlying hemodynamic pathophysiology or an effective evidence-based treatment.

CASE: A 45-year-old woman with a documented placenta previa experienced an amniotic fluid embolism during scheduled cesarean delivery. Transesophageal echocardiogram examination revealed catastrophic pulmonary vasoconstriction. The use of cardiopulmonary bypass, heparin, epinephrine, and high-dose steroids resulted in a successful outcome.

CONCLUSION: Timely placement of transesophageal echocardiogram revealed catastrophic pulmonary vasoconstriction as the cause of circulatory collapse in a patient with amniotic fluid embolism, supporting the use of cardiopulmonary bypass as an effective intervention.




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