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Perfusion 2022 May 13:2676591221090668. Epub 2022 May 13.

Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany.

Introduction: Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO cases and further assess the indications and outcomes of ECMO in this setting across multiple centers and countries.

Methods: A retrospective, multicenter, international cohort study of pregnant and peripartum ECMO cases was performed. Read More

BMC Pregnancy Childbirth 2022 Apr 28;22(1):369. Epub 2022 Apr 28.

Department of Anesthesiology, West China Second University Hospital; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China.

Background: For a healthy parturient, a cardiopulmonary collapse that suddenly occurs shortly after an uneventful caesarean section is a relatively rare event and presents a significant challenge for the anesthesia provider.

Case Presentation: Amniotic fluid embolism (AFE) is characterized by acute and rapid collapse and is well known to the obstetric team. Our patient experienced sudden cardiovascular collapse, severe respiratory difficulty and hypoxia, in the absence of other explanations for these findings at the time, and thus AFE was immediately become the focus of the consideration. Read More

J Trauma Acute Care Surg 2022 Apr 21. Epub 2022 Apr 21.

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used for postpartum hemorrhage (PPH) which is one of the leading causes of maternal mortality worldwide; however, its utility in the obstetrics setting remains unclear. Thus, this study aimed to describe the characteristics, demographics and mortality of patients with PPH who underwent REBOA.

Methods: We used the Japanese Diagnosis Procedure Combination inpatient database to identify patients with PPH who underwent REBOA from April 2012 to March 2020. Read More

World J Clin Cases 2022 Mar;10(8):2439-2446

Department of Clinical Laboratory, Hai'an Qutang Central Health Center, Hai'an 226600, Jiangsu Province, China.

Background: Obstetric hemorrhage is the leading cause of maternal mortality globally, especially in China. The key to a successful rescue is immediate and rapid blood transfusion. Autotransfusion has become an integral part of clinical blood transfusion, with intraoperative cell salvage (IOCS) being the most widely used. Read More

Arch Gynecol Obstet 2022 Apr 9. Epub 2022 Apr 9.

Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, No. 1 Xueshi Road, Hangzhou, 310000, China.

Purpose: This study aimed to estimate the incidence of fatal amniotic fluid embolism, describe its risk factors, and analyze perinatal outcomes.

Methods: Maternity cases and newborn records of amniotic fluid embolism were collected from the Zhejiang Maternal Surveillance System from October 2006 to October 2019. This study strictly limited the diagnostic criteria for AFE and excluded suspicious cases in order to minimize false-positive AFE cases. Read More

Crit Care 2022 04 7;26(1):96. Epub 2022 Apr 7.

Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France.

Background: Amniotic fluid embolism (AFE) is a rare but often catastrophic complication of pregnancy that leads to cardiopulmonary dysfunction and severe disseminated intravascular coagulopathy (DIC). Although few case reports have reported successful use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) with AFE, concerns can be raised about the increased bleeding risks with that device.

Methods: This study included patients with AFE rescued by VA-ECMO hospitalized in two high ECMO volume centers between August 2008 and February 2021. Read More

Cureus 2022 Feb 21;14(2):e22475. Epub 2022 Feb 21.

Anesthesiology/Critical Care, Hamad General Hospital, Doha, QAT.

Amniotic fluid embolism (AFE) is a rare but devastating complication of pregnancy and is associated with high morbidity and mortality. Identifiable maternal risk factors for AFE include older age, multiparity, cesarean section, and placenta previa, while fetal factors include male gender, fetal distress, and death. AFE presents with respiratory distress, seizure, and circulatory collapse and can be complicated with disseminated intravascular coagulopathy, multiorgan failure, and death. Read More

BMC Pregnancy Childbirth 2022 Mar 26;22(1):252. Epub 2022 Mar 26.

Department of Anesthesiology, West China Hospital of Sichuan University, No. 37, Guoxue Road, Sichuan, 610041, Chengdu, P. R. China.

Background: Amniotic fluid embolism (AFE) is a rare disease that can lead to profound coagulopathy and hemorrhage, especially when combined with the laceration and bleeding of other organs. Intraoperative cell salvage (ICS) has been widely used for treating obstetric hemorrhage, but it remains unclear whether ICS can be used in the treatment of AFE.

Case Presentation: We report the case of a 27-year-old woman at 39 weeks' gestation who suddenly developed severe abdominal pain, convulsions, loss of consciousness, and decreased vital signs during labor. Read More

Z Geburtshilfe Neonatol 2022 Apr 16;226(2):139-141. Epub 2022 Feb 16.

Department of Internal Medicine, Clinical Hospital "Sveti Duh" Zagreb, Croatia.

We report and discuss the case of a 29-year-old tercigravida with intrapartum cardiorespiratory arrest due to a massive amniotic fluid embolism and disseminated intravascular coagulopathy. Perimortem caesarean section with B-Lynch compression uterine suture with simultaneous fetal and maternal resuscitation were performed with a favorable outcome for both the mother and the child. Read More

Eur J Med Res 2022 Feb 3;27(1):19. Epub 2022 Feb 3.

Department of Anesthesiology, Third Affiliated Hospital, Guangzhou Medical University, No. 67, Duobao Road, Liwan District, Guangzhou, 510150, China.

Background: Amniotic fluid embolism (AFE) is a rare but potentially dangerous severe obstetrics complication, which is accompanied by an incidence between 1.9 and 6.1 per 100,000 births. Read More

J Blood Med 2022 6;13:21-44. Epub 2022 Jan 6.

Department of Haematology, Manchester Royal Infirmary, Manchester, UK.

Obstetrical hemorrhage and especially DIC (disseminated intravascular coagulation) is a leading cause for maternal mortality across the globe, often secondary to underlying maternal and/or fetal complications including placental abruption, amniotic fluid embolism, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), retained stillbirth and acute fatty liver of pregnancy. Various obstetrical disorders can present with DIC as a complication; thus, increased awareness is key to diagnosing the condition. DIC patients can present to clinicians who may not be experienced in a variety of aspects of thrombosis and hemostasis. Read More

CASE (Phila) 2021 Dec 16;5(6):354-357. Epub 2021 Oct 16.

Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.

Cureus 2021 Nov 15;13(11):e19590. Epub 2021 Nov 15.

Internal Medicine, University of California Los Angeles, Los Angeles, USA.

Postpartum dyspnea can be due to many causes, such as pulmonary embolism, amniotic fluid embolism, peripartum cardiomyopathy, but less frequently due to acute pulmonary edema. The incidence of acute pulmonary edema during pregnancy and in the postpartum period has been estimated to be around 0.08%. Read More

Ugeskr Laeger 2021 11;183(48)

Amniotic fluid embolism (AFE) is a rare obstetric emergency with high maternal morbidity and mortality. Despite ongoing research, the pathogenesis of AFE remains unresolved, and AFE is a diagnostic and therapeutic challenge. We present a case report of suspected AFE and disseminated intravascular coagulation occurring during caesarean delivery in a pregnancy with oocyte donation and intracytoplasmic sperm injection. Read More

Medicine (Baltimore) 2021 Nov;100(46):e27896

Department of Intensive Medicine, Hebei General Hospital, Shijiazhuang City, Hebei Province, P.R. China.

Rationale: Amniotic fluid embolism (AFE) is a rare obstetrical complication and is a leading cause of maternal death in developed countries. Despite the development of supportive therapeutic measures, the mortality rate remains high.

Patient Concerns: A 38-year-old nulliparous pregnant woman, who underwent in vitro fertilization-embryo transfer, was admitted for labor at 37 weeks' gestation. Read More

Anesthesiol Clin 2021 Dec;39(4):687-709

Duke University Medical Center, DUMC 3094, MS#9, 2301 Erwin Road, Durham, NC 27710, USA. Electronic address:

Postpartum respiratory depression is a complex, multifactorial issue that encompasses a patient's baseline preexisting conditions, certain pregnancy-specific conditions or complications, as well as the iatrogenic element of various medications given in the peripartum period. In this review, we discuss many of these factors including obesity, sleep-disordered breathing, chronic lung disease, neuromuscular disorders, opioids, preeclampsia, peripartum cardiomyopathy, postpartum hemorrhage, amniotic fluid embolism, sepsis, acute respiratory distress syndrome (ARDS), and medications such as analgesics, sedatives, anesthetics, and magnesium. Current recommendations for screening, treatment, and prevention are also discussed. Read More

BMC Public Health 2021 10 5;21(1):1792. Epub 2021 Oct 5.

Department of Women Healthcare, Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, 250012, People's Republic of China.

Background: China was one of the few countries to achieve the Millennium Development Goals 5. China had taken many effective measures to reduce maternal mortality ratio (MMR) and has achieved encouraging progress. These measures were worth sharing for other countries to reduce the MMR, but the introduction of these measures from the national perspective was too grand, and the measures implemented in a city and the results achieved were more valuable. Read More

BMJ Open 2021 09 28;11(9):e047983. Epub 2021 Sep 28.

Department of Obstetrics, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China

Objectives: This study aims to use the high-quality national monitoring data from the China's National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric massive blood transfusion (MBT) from 2012 to 2019 in China and determine its clinical outcomes.

Settings: Observational study of hospitalised pregnancies who had given birth or ended their pregnancy among member hospitals of NMNMSS.

Participants: 11 667 406 women were included in this study. Read More

J Clin Med 2021 Sep 9;10(18). Epub 2021 Sep 9.

Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo 160-8582, Japan.

Indications for the use of transarterial embolization (TAE) for postpartum hemorrhage (PPH) have been established. However, the efficacy of TAE for PPH complicated by disseminated intravascular coagulation (DIC) remains controversial. In this study, we investigated the efficacy of TAE for PPH complicated by DIC. Read More

Wiad Lek 2021 ;74(8):2011-2015

DEPARTMENT OF INTERNAL MEDICINE AND CARDIOLOGY, MEDICAL UNIVERSITY OF WARSAW, WARSAW, POLAND.

Objective: Amniotic fluid embolism (AFE) is a diagnostically challenging type of pulmonary embolism that occurs when amniotic fluid enters maternal circulation during delivery or postpartum. This obstetric complication is very rare but characterized by high mortality rate. The main symptoms are dyspnea, cardiovascular collapse, disseminated intravascular coagulation (DIC) and even sudden cardiac death. Read More

J Clin Med 2021 Aug 31;10(17). Epub 2021 Aug 31.

Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. Read More

J Perinat Med 2021 11 10;49(9):1163-1164. Epub 2021 Sep 10.

Department of Obstetrics, School of Medicine, Università degli Studi di Milano-Bicocca, Monza, Italy.

Eur J Obstet Gynecol Reprod Biol 2021 Oct 9;265:219-220. Epub 2021 Aug 9.

University of Louisville, Department of Anesthesiology and Perioperative Medicine, Louisville, KY, United States. Electronic address:

Autops Case Rep 2021 20;11:e2021311. Epub 2021 Aug 20.

Mercer University School of Medicine, Department of Pathology and Clinical Science Education, Macon, GA, USA.

Amniotic fluid embolism is a rare, often fatal complication of labor and delivery. The classic presentation is the sudden onset of a triad of clinical manifestations: hypoxia, hypotension and coagulopathy. Understanding of the syndrome as an immunologically mediated, complicated and often catastrophic maternal response to fetal or placental antigens is coming into focus. Read More

PLoS One 2021 26;16(8):e0256693. Epub 2021 Aug 26.

Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine, Tokyo, Japan.

Induction and augmentation of labor is one of the most common obstetrical interventions. However, this intervention is not free of risks and could cause adverse events, such as hyperactive uterine contraction, uterine rupture, and amniotic-fluid embolism. Our previous study using a new animal model showed that labor induced with high-dose oxytocin (OXT) in pregnant mice resulted in massive cell death in selective brain regions, specifically in male offspring. Read More

Zhonghua Fu Chan Ke Za Zhi 2021 Aug;56(8):537-544

Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.

To investigate the safety, efficacy and application indication of intra-operative cell salvage (IOCS) in cesarean section. A total of 1 265 pregnant women who received IOCS blood transfusion during cesarean section in 11 tertiary A hospitals from August 2016 to January 2019 were collected and divided into <1 500 ml group (796 cases) and ≥1 500 ml group (469 cases) according to the amount of blood loss during cesarean section. The general clinical data, ultrasonic imaging data, perinatal and puerperium indicators were analyzed retrospectively. Read More

Sci Rep 2021 08 12;11(1):16379. Epub 2021 Aug 12.

Department of Intensive Care Unit, Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing, China.

We aimed to determine disseminated intravascular coagulation (DIC)-associated organ failure and underlying diseases based on data from three ICU wards in tertiary hospitals in China from 2008 to 2016. The diagnosis of DIC was confirmed by an International Society of Thrombosis and Hemostasis score greater than or equal to 5. The maternal outcomes included the changes in organ function 24 h after ICU admission. Read More

Can J Anaesth 2021 10 26;68(10):1541-1548. Epub 2021 Jul 26.

Division of Critical Care, Department of Medicine, Jewish General Hospital, McGill University, 3755 ch. de la Côte-Sainte-Catherine Rd, Suite H-364.1, Montreal, QC, H3T 1E2, Canada.

Purpose: Amniotic fluid embolism (AFE) is a rare, but often fatal condition characterized by sudden hemodynamic instability and coagulopathy occurring during labour or in the early postpartum period. As the mechanisms leading to shock and the cardiovascular effects of AFE are incompletely understood, the purpose of this case series is to describe how AFE presents on echocardiography and review limited reports in the literature.

Clinical Features: We describe three cases of AFE at the Jewish General Hospital, a tertiary care centre in Montreal, Canada. Read More

Pan Afr Med J 2021 1;38:325. Epub 2021 Apr 1.

Anesthesia-Intensive Care Department B, Maternity and Neonatology Teaching Center of Monastir, Monastir, Tunisia.

Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy and child birth. Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report AFE as a leading cause of mortality in the pregnant population. It has a heterogeneous presentation. Read More

BJOG 2021 11 29;128(12):1974. Epub 2021 Jul 29.

Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.