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///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

Intraoperative Diagnosis of Amniotic Fluid Embolism by Transthoracic Echocardiography during Emergent Cesarean Section

Abstract Number: SAT-75
Abstract Type: Case Report/Case Series

julin F Tang MD, MS1 ; Gregory Chinn MD2; Nicole Jackman MD3; John Markley MD4

Amniotic fluid embolism is a rare complication with significant maternal mortality in pregnancy. We are presenting a case of amniotic fluid embolism diagnosed by the application of intraoperative transthoracic echocardiography. A 29-year-old G3P2 with no significant medical history except bipolar disorder was admitted for induction of labor. She refused to have epidural analgesia for her labor pain. Her progression of labor was smooth until the day of emergent Cesarean section due to the vaginal bleeding and a sudden finding of fetal distress. She was emergently taken to the operating room for a crash C-section under general anesthesia. She was intubated with propofol and succinylcholine successfully. A baby girl was delivered within a couple minutes after intubation. The baby’s APGAR score was 1/7/8. The obstetric surgeons noted a rupture of left side lower uterine segment. Massive transfusion protocol was activated. Additional 16 gauge PIV and a right radial a-line were established. 5 minutes after the baby delivered, the patient had a sudden onset of low SpO2 and SBP decreased to around 50's. DDx of hemorrhagic shock, anaphylaxis, and amniotic fluid embolism were entertained. Initial ABG showed PaO2 of 51 mmHg and a hct of 20%. She had received a total of 7 u of pRBC, 6 u of FFP, and 1 u of plts. She had also received 32 mcg of epinephrine and 20 units of vasopressin to maintain a stable BP. Intraoperative TTE revealed a flattened interventricular septum on PSAX view and a dilatation of right ventricle with prominent apical trabecular component on AP4 view. The follow-up TTE performed after ICU admission demonstrated the RV dilatation had returned to normal as well as the rest of the exam.

References

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