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Re: Cytotec and hypotonic uterusFrom: Diane Petersen (peter261@gold.tc.umn.edu)Sun Apr 9 19:31:42 2000
The mother was in early labor with ruptured membranes. She experienced another gush of fluid followed by much more painful contractions, diarrhea and became anxious. Fetal bradycardia was present after these changes occurred in the mother. She did not show signs of cardiopulmonary compromise. At C/S for fetal bradycardia there was normal clotting at the start of the case. It was when I was closing the fascia that oozing began and DIC became apparent. We were then in the OR for another 3-4 hours trying to correct the coagulopathy and uterine hypotonia so that I could close the abdomen. Thankfully, this was the first amniotic fluid embolism to occur in my career (15 years). I have carried a card in my wallet with a protocol for AFE management since I was an intern. After my recent experience I have been able to add a few more things that were advantageous to my patient. I also have reviewed the literature on the subject and found that fetal bradycardia may be the first sign of an AFE. There are three classic presentations of AFE: cardiopulmonary collapse, hemorrhage/DIC, and seizure. In residency I only learned of the first presentation. I hope to never see this again.
-- Diane Petersen MD FACOG Mpls MN Private practice
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