///2011 Abstract Details
2011 Abstract Details2018-05-01T17:54:20+00:00

Good maternal and neonatal outcome after near fatal amniotic fluid embolism with early transesophageal echocardiography and cardiopulmonary bypass intervention

Abstract Number: 94
Abstract Type: Case Report/Case Series

Mara A Grossman MD1 ; Mona Halim-Armanios MD2; Galina Dimitrova MD3


A 36 y/o G5P2 parturient at 40 weeks was admitted for induction of labor due to polyhydramnios. Standard epidural placement was followed by mental status changes that quickly progressed to unresponsiveness and circulatory collapse. Emergent cesarean section was performed while providing CPR. Following delivery, the patient developed uncontrollable uterine hemorrhage. Transesophageal echocardiography demonstrated a large right pulmonary artery thrombus, a dilated hypokinetic right ventricle with tricuspid regurgitation, and a hyperkinetic left ventricle. In addition to massive transfusion, emergent pulmonary embolectomy with cardiopulmonary bypass was performed. Despite mild cognitive deficits, the patient made a rapid recovery.


1.Clark SL, et al. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008; 199: 36.

2.Clark SL, et al. Amniotic fluid embolism: Analysis of the national registry. Am J Obstet Gynecol 1995; 172: 1158-69.

3.Stanten RD, et al. Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass. Obstet Gynecol 2003; 102: 496-8.

4.Prosper SC, et al. Recombinant factor VIIa to successfully manage disseminated intravascular coagulation from amniotic fluid embolism. Obstet Gynecol 2007; 109: 524-5.Kaneko Y, et al. Continuous hemodiafiltration for disseminated intravascular coagulation and shock due to amniotic fluid embolism: report of a dramatic response. Intern Med. 2001; 40: 945-7.

6.Attwood HD, et al. Embolism to the lungs by trophoblast. J Obstet Gynaecol Br Cmnwlth 1961; 68:611-17

7.Clark SL, et al. New concepts of amniotic fluid embolism: a review. Obstet Gynecol Surv. 1990; 45: 360-368

8.Katz V, Balderston K, DeFreest M. Perimortem cesarean delivery: Were our assumptions correct? American Journal of Obstet and Gynecology (2005) 192: 1916-1920.

9.Benson. Nonfatal amniotic fluid embolism: three possible causes and a new clinical definition. Arch Fam Med 1993; 2:989-94.

SOAP 2011