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Amniotic fluid embolism: Principles of early clinical management

Luis D Pacheco, Steven L Clark, Miranda Klassen, Gary D V Hankins
American Journal of Obstetrics and Gynecology 2019 July 31
Amniotic fluid embolism is an uncommon but potentially lethal complication of pregnancy. As amniotic fluid embolism usually presents with cardiac arrest, the initial immediate response should be to provide high quality cardiopulmonary resuscitation. We describe key features of initial management of patients with amniotic fluid embolism. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible since this is an easy and reliable method of identifying a failing right ventricle. If such failure is identified, management tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. Amniotic-fluid-embolism-related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen above 150-200 mg/dL). In cases requiring prolonged cardiopulmonary resuscitation or post arrest severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.


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