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Re: AMNIOTIC FLUID EMBOLISMFrom: D. Ashley Hill, M.D. (anonymous@obgyn.net)Wed, 8 Oct 1997 19:23:05 -0500 (CDT)
At Wed, 8 Oct 1997, anonymous@obgyn.net wrote: > >I HAD AN AMNIOTIC FLUID EMBOLISM 90 MINUTES AFTER THE BIRTH OF MY SON IN >3/97. IT WAS FOLLOWED BY THE PICTUIRE OF DIC (DISSENSEMINATED INTRAVASCULAR >COAGULATION). I WAS TREATED WITH MANY UNITS OF BLOOD, FFP & CRYO. AFTER >ALMOST A WEEK IN THE HOSPITAL I WAS RELEASED. THE BABY WAS AND IS FINE. Lisa- First of all, congratulations on surviving this traumatic situation. The fact that both you and your baby are doing well is truly exceptional, as about 6 out of 10 women who have this rare complication of pregnancy die. Unfortunately, many of the few survivors suffer long-term neurologic defects similar to patients who have had a stroke. Many babies die, also. (Although we may consider death during pregnancy rare in the U.S., 500,000 women a year die worldwide during pregnancy or childbirth). Amniotic fluid embolism occurs in somewhere between 1 in 8,000 to 1 in 80,000 pregnancies, and develops when amniotic fluid (the water bag) enters the blood vessels of the uterus and travels rapidly to the heart and lungs. Tiny little "clots" of amniotic fluid and other cells plug up the blood vessels in the lungs and cause massive respiratory distress and perhaps seizures and cardiac failure. The amniotic fluid, or something produced in response to it, affects the cells in the blood stream and the blood cannot clot, producing DIC. Many women end up in a coma, but some, like yourself, survive and do fine. Amniotic fluid embolism is a pure case of "bad luck" and is not caused by any intervention, test, or procedure. It is one of those things, like lightning strikes or encephalitis from a mosquito bite, that "just happen." In the past we thought that oxytocin (pitocin) administration may be related, but this is untrue. In our society malpractice lawyers would have us believe that these situations must be because of someone's fault, but, again, they are unpreventable tragedies. Treatment consists of rapidly delivering the baby (usually by c/section), initiation of CPR for the mother, blood transfusion, and a lot of prayer. Blood products, sometimes in excess of 100 units of blood, are necessary. I have had 2 cases of this. The last one, less than a year ago, resulted in so much blood on the operating room floor that it was producing waves as people walked through it. I threw away my shoes, socks, scrubs, and underwear, as all were soaked with blood. One minute the lady was calmly going through labor, the next she was dead. We effectively revived her (twice) and after an emergency hysterectomy and some time in a coma she survived. Both she and her baby are doing great. I distinctly remember putting stitches in as fast as I could, as blood went everywhere, and saying "please, God, don't let this lady die." These events are extremely traumatic for the doctors and nurses caring for the patient, also, as we want nothing more than for both mother and baby to be healthy. I doubt they recur in subsequent pregnancies, but I have never read a medical paper on recurrent AFE. I am extraordinarily happy to hear that you and your baby are doing well. I hope that this brief summary of AFE has answered your questions.
-- Ashley Hill D. Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL I apologize, but I am unable to answer personal e-mail due to time constraints.
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