Anaes SAQs · Obstetric anaesthesia
Amniotic fluid embolism: recognition and management
Final-examination SAQ.
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ANZCAFRCAEDAICABAFCAI
Prompt
Immediately after placental delivery a woman becomes profoundly hypoxic, hypotensive, then bleeds from IV sites with a fibrinogen of 0.8 g/L. Discuss diagnosis, immediate resuscitation, cardiovascular support, and coagulopathy management.
Model answer
Diagnosis (3). Clinical AFE: sudden hypoxia/hypotension in peripartum window with DIC; exclude PE, haemorrhage, high spinal, LAST, anaphylaxis.[1][2]
Resuscitation (6). Help, airway, 100 percent O2, circulatory support, echo-guided RV care, deliver if needed, early ICU/ECMO consideration.[3][5]
DIC (6). Massive haemorrhage protocol, fibrinogen-focused replacement, plasma/platelets, TXA if bleeding, surgical control.[6]
References6ShowHide
- [1]Pacheco LD, Saade G, Hankins GD, et al. Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol, 2016.PMID 26987420
- [2]Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol, 2016.PMID 27372270
- [3]Pacheco LD, Clark SL, Klassen M, et al. Amniotic fluid embolism: principles of early clinical management. Am J Obstet Gynecol, 2020.PMID 31376394
- [4]Wiseman D, Simard C, Yang SS, et al. Echocardiography findings in amniotic fluid embolism: a systematic review of the literature. Can J Anaesth, 2023.PMID 36307749
- [5]Viau-Lapointe J, Filewod N Extracorporeal Therapies for Amniotic Fluid Embolism. Obstet Gynecol, 2019.PMID 31599831
- [6]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN). Lancet, 2017.PMID 28456509