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Recombinant Factor VIIa to Successfully Manage Disseminated Intravascular Coagulation From Amniotic Fluid Embolism

From the ¹Department of Maternal Fetal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

BACKGROUND: Amniotic fluid embolism (AFE) is a rare syndrome that can complicate pregnancy and labor. It often has debilitating and lethal consequences. One serious sequela of AFE is disseminated intravascular coagulation (DIC).

CASE: This report describes an atypical presentation of AFE manifested by sudden fetal bradycardia and complicated by maternal DIC. The DIC was eventually successfully treated with the use of recombinant activated factor VIIa.

CONCLUSION: The use of recombinant activated factor VIIa in cases of massive hemorrhage, such as in our patient, is controversial but has been shown, in some cases, to reverse DIC and be successful. The use of recombinant activated factor VIIa should be considered in patients with massive obstetric hemorrhage in whom standard measures of stabilization are unsuccessful.