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Taiwan J Obstet Gynecol 2021 May;60(3):579-580

Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan.

Eur Heart J Cardiovasc Imaging 2021 May 8. Epub 2021 May 8.

Department of Internal Medicine III (Cardiology, Pneumology, Intensive Care), Klinikum Passau, Innstrasse 76, 94032 Passau, Germany.

Sci Rep 2021 Apr 16;11(1):8379. Epub 2021 Apr 16.

Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan.

This study aimed to determine whether blood loss and fibrinogen can differentiate amniotic fluid embolism (AFE) from postpartum haemorrhage (PPH). This retrospective case-control study included nine patients with clinical AFE ("AFE group") and 78 patients with PPH managed at our tertiary care perinatal centre between January 2014 and March 2016. Patients meeting the Japanese diagnostic criteria for AFE were stratified into cardiopulmonary collapse-type AFE and disseminated intravascular coagulation (DIC)-type AFE groups. Read More

Anaesthesist 2021 Apr 13. Epub 2021 Apr 13.

Klinik für Anästhesiologie, Universitätsmedizin Mainz, Mainz, Deutschland.

As the incidence of diseases during pregnancy that necessitate intensive medical care is very low, intensive care physicians are faced with a multitude of unfamiliar challenges in the treatment of these patients. The physiological and pathophysiological alterations during pregnancy induce some specific features with respect to the intensive medical treatment of pregnant or postpartum patients. After the most important principles and current recommendations on the care of pregnant or postpartum patients who need intensive medical treatment were dealt with in the first article in this CME series, the second article focuses on the diagnostics and treatment of special selected pathologies. Read More

J Obstet Gynaecol Res 2021 Apr 11. Epub 2021 Apr 11.

Department of Obstetrics and Gynecology, Yamaguchi University Graduate School of Medicine, Ube, Japan.

Twin-twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionic twin pregnancies and is associated with almost 90% mortality if left untreated. Fetoscopic laser photocoagulation (FLP) is the first-line therapy for TTTS, and an overall twin survival rate of 75% and at least one survival rate of 90% have been established. We report a case of TTTS complicated with bleeding from the uterine wall by inserting the procedure after FLP. Read More

Cureus 2021 Feb 26;13(2):e13566. Epub 2021 Feb 26.

Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.

Amniotic fluid embolism (AFE) is a rare and life-threatening complication related to pregnancy. Early diagnosis and prompt intervention are important tools for the survival of the patient. Despite early intervention, mortality rate remains high. Read More

J Obstet Gynaecol Res 2021 May 14;47(5):1743-1750. Epub 2021 Mar 14.

Department of Obstetrics and Gynecology, Toho University School of Medicine, Tokyo, Japan.

Aim: Intraoperative cell salvage and autotransfusion (ICSA) is a useful technique for women undergoing cesarean sections who are predicted to experience significant bleeding. This method can reduce allogeneic transfusions as well as its associated risks and costs. Amniotic fluid embolism (AFE) is an abnormal maternal response to ICSA similar to the classic systemic inflammatory response syndrome, but its mechanism is not well understood. Read More

Eur Rev Med Pharmacol Sci 2021 Feb;25(4):1796-1803

Department of Critical Care Medicine, the Affiliated Dalian Municipal Central Hospital of Dalian Medical University, Dalian, P.R. China.

Amniotic fluid embolism (AFE) is a rare but severe obstetric complication with high mortality. To date, the pathogenesis of AFE has evolved from a simple theory of mechanical obstruction to an immunological theory. However, it is not yet fully understood. Read More

Rev Neurol (Paris) 2021 Mar 26;177(3):203-214. Epub 2021 Feb 26.

Stroke unit, Saint-Antoine hospital, APHP, Sorbonne Université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Unité INSERM U938 centre de recherche Saint Antoine, Université Sorbonne Paris.

Though cerebrovascular complications of pregnancy remain relatively rare, they represent a potentially devastating event that necessitates prompt identification and treatment. Eighteen percent of strokes occurring in young women are linked to pregnancy. They occur mostly in the third trimester or during the post-partum period. Read More

BJOG 2021 Feb 17. Epub 2021 Feb 17.

Department of Anaesthesia and Intensive Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.

Objective: To assess the contribution of maternal blood detection of IGFBP-1 for the diagnosis of amniotic-fluid embolism in clinical daily practice.

Design: A retrospective multicentre cohort study.

Setting: Three tertiary care obstetric units in France. Read More

Pathol Int 2021 Apr 9;71(4):223-231. Epub 2021 Feb 9.

Department of Pathology, Osaka Women's and Children's Hospital, Osaka, Japan.

The maternal mortality rate in Japan was 3.5 per 100 000 live births in 2017, similar to that reported in other developed countries. To reduce the number of maternal deaths, a Japanese nationwide registration and analysis system was implemented in 2010. Read More

J Perinat Med 2021 Jan 19. Epub 2021 Jan 19.

Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.

Objectives: An international diagnostic criterion for amniotic fluid embolism (AFE) diagnosis has recently been published. Data regarding subsequent pregnancies is scarce. We sought to implement recent diagnostic criteria and detail subsequent pregnancies in survivors. Read More

Obstet Gynecol Sci 2021 Mar 28;64(2):190-200. Epub 2020 Dec 28.

Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: This study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosed by maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteria by the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomes between cases satisfying all 4 criteria and cases with at least 1 missing criterion.

Methods: This study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collected information, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. Read More

Am J Obstet Gynecol 2021 04 6;224(4):B29-B32. Epub 2021 Jan 6.

Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.

Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience in managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. Read More

Clin Case Rep 2020 Dec 26;8(12):3359-3361. Epub 2020 Oct 26.

B.P. Koirala institute of Health Sciences Dharan Nepal.

High index of suspicion of amniotic fluid embolism should be considered in any intrapartum or postpartum collapse where the obvious cause of collapse is not identified. Read More

Zhonghua Fu Chan Ke Za Zhi 2020 Dec;55(12):823-829

Fetal Medicine Unit, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai 201204, China.

To analyze the perioperative maternal complications of twin-twin transfusion syndrome (TTTS) after fetolascopic laser photocoagulation (FLP). A retrospective study was conducted among 182 cases with TTTS received FLP in Shanghai First Maternity and Infant Hospital from January 2010 to December 2018. The types, incidence and related factors of perioperative maternal complications as well as the changes of maternal laboratory parameters before and after FLP were analyzed. Read More

Am J Obstet Gynecol MFM 2020 05 9;2(2):100083. Epub 2020 Jan 9.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX.

Background: Incidence, risk factors, and perinatal morbidity and mortality rates related to amniotic fluid embolism remain a challenge to evaluate, given the presence of differing international diagnostic criteria, the lack of a gold standard diagnostic test, and a significant overlap with other causes of obstetric morbidity and mortality.

Objective: The aims of this study were (1) to analyze the clinical features and outcomes of women using the largest United States-based contemporary international amniotic fluid embolism registry, and (2) to investigate differences in demographic and obstetric variables, clinical presentation, and outcomes between women with typical versus atypical amniotic fluid embolism, using previously published and validated criteria for the research reporting of amniotic fluid embolism.

Materials And Methods: The AFE Registry is an international database established at Baylor College of Medicine (Houston, TX) in partnership with the Amniotic Fluid Embolism Foundation (Vista, CA) and the Perinatology Research Branch of the Division of Intramural Research of the NICHD/NIH/DHHS (Detroit, MI). Read More

BJOG 2021 Jun 18;128(7):1200-1205. Epub 2021 Feb 18.

Obstetric Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Objectives: To describe the characteristics and factors which may influence the maternal outcomes of maternal cardiac arrest (MCA).

Design: Retrospective analysis of cases.

Setting: China. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2020 Nov 26;55(11-12):674-685. Epub 2020 Nov 26.

A A Pract 2020 Nov;14(13):e01342

From the Department of Anesthesia, McMaster University, Hamilton, Ontario.

We present a patient with sudden cardiovascular collapse during cesarean delivery that was attributed to amniotic fluid embolism (AFE). The syndrome of AFE may be initiated by an anaphylactoid response to amniotic fluid in the maternal circulation that triggers the release of pulmonary vasoconstrictors, with transient pulmonary vasospasm, causing hemodynamic collapse and profound left ventricular failure. Milrinone, a pulmonary vasodilator used in the management of emergent right ventricular failure, was administered via a nebulizer in an effort to decrease pulmonary vascular resistance. Read More

A A Pract 2020 Nov;14(13):e01349

From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.

Amniotic fluid embolism (AFE) is a rare but devastating condition with mortality rates as high as 60%-80%., We report a case of AFE complicating the labor of a parturient with no reported risk factors. She received general anesthesia for emergent cesarean delivery (CD), after which she developed a pulseless electrical activity (PEA) event requiring resuscitation, disseminated intravascular coagulation, and postpartum hemorrhage with undetectable fibrinogen activity by ROTEM FIBTEM assay. Read More

Gynecol Obstet Fertil Senol 2021 Jan 5;49(1):47-52. Epub 2020 Nov 5.

Département de gynécologie obstétrique, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France.

Amniotic fluid embolism remains the 3rd cause of maternal death in France, with a stable rate and 28 deaths in this triennium, representing 10.7% of maternal deaths and a maternal mortality ratio of 1.2/100,000 live births. Read More

J Obstet Gynaecol 2020 Nov 3:1-6. Epub 2020 Nov 3.

Department of Obstetrics and Gynecology, Shanghai Jiading Maternity & Infant Health Hospital, Tongji University Teaching Hospital, Shanghai, China.

Worldwide, the incidence of postpartum haemorrhage (PPH) is ∼6% and it is the leading cause of maternal mortality. The present study introduces a non-invasive procedure called bilateral cervix apex clamping (BCAC) as a new treatment for refractory PPH. A total of 13 vaginal deliveries and 5 caesarean section patients received the BCAC procedure to stop bleeding. Read More

Crit Care Med 2020 Dec;48(12):e1251-e1259

All authors: Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan.

Objectives: Amniotic fluid embolism is a rare disease that induces fatal coagulopathy; however, due to its rarity, it has not yet been examined in detail. The strict diagnostic criteria by Clark for amniotic fluid embolism include severe coagulopathy complicated by cardiopulmonary insufficiency, whereas the Japanese criteria also include postpartum hemorrhage or Disseminated Intravascular Coagulation in clinical practice. Amniotic fluid embolism cases with preceding consumptive coagulopathy may exist and are potential clinical targets for earlier assessments and interventions among amniotic fluid embolism cases fulfilling the Japanese, but not Clark criteria. Read More

J Perinat Med 2021 Feb 4;49(2):166-169. Epub 2020 Sep 4.

Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Tsu, Japan.

Objectives: The objectives of this study were to (i) establish the reference range and mean value for normal levels of C1-esterase inhibitor (C1 INH) during pregnancy, and (ii) investigate the association between C1 INH and uterine atony, as measured by blood loss at delivery.

Methods: We prospectively studied 200 healthy pregnant women who were registered. We studied C1 INH levels in 188 women at 34 and 35 gestational weeks of pregnancy. Read More

Medicine (Baltimore) 2020 Aug;99(35):e21916

Anesthesiology Department of West China Second University Hospital, Sichuan University, Sichuan Province.

Pernicious placenta previa (PPP) is the main cause of severe obstetric postpartum hemorrhage and hysterectomy and often requires donor blood transfusion. Prophylactic internal iliac artery (IIA) balloon occlusion (BO) combined with cell salvage is increasingly being deployed in parallel transverse uterine incision (PTUI) cesarean section (CS). The aim of this study was to explore the differences in blood management in PTUI CS with or without prophylactic IIA BO and to evaluate the safety and efficacy of cell salvage to reduce the need for donor blood transfusion during PTUI CS. Read More

Crit Care Explor 2020 Jul 16;2(7):e0162. Epub 2020 Jul 16.

Department of Anesthesiology, Division of Critical Care Medicine, Emory University, Atlanta, GA.

Amniotic fluid embolism is a rare obstetric emergency that can be accompanied by profound hypoxemia, coagulopathy, hemorrhage, and cardiogenic shock. Extracorporeal membrane oxygenation may provide a rescue strategy in amniotic fluid embolism with cardiopulmonary collapse. Approaches to anticoagulation must be balanced against the risk of hemorrhage with concomitant coagulopathy. Read More

J Thromb Thrombolysis 2021 Apr;51(3):818-820

Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-ku Osaka, Osaka, 545-8585, Japan.

Amniotic fluid embolism (AFE) is a catastrophic condition in the peripartum period and still remains as a leading cause of maternal death. Although over 80% of cases of AFE cases are accompanied by coagulopathy, the pathology of disseminated intravascular coagulation is not well understood not only because of its rarity but also because of the limited availability of laboratory testing in emergent clinical settings. We describe a case of AFE whose characteristic data for coagulation and fibrinolysis were timely depicted with sequential thromboelastography. Read More

BMC Pregnancy Childbirth 2020 Jul 14;20(1):406. Epub 2020 Jul 14.

Department of Obstetrics and Gynecology, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shimizu-ku, Shizuoka-shi, Shizuoka, 424-8636, Japan.

Background: Amniotic fluid embolism (AFE), also known as anaphylactoid syndrome of pregnancy (ASP), typically occurs during labor and may result in cardiorespiratory collapse and disseminated intravascular coagulation (DIC). There are reports describing less typical presentations of AFE/ASP in which patients do not necessarily have the classic triad of hypoxia, hypotension, and coagulopathy. AFE/ASP rarely occurs in the absence of labor, but such cases may involve medical or surgical abortion, spontaneous miscarriage, or obstetrical procedures including amniocentesis and amnioinfusion. Read More