Amniotic fluid embolism with second trimester pregnancy termination: A case report

Barry K. Ray, Manuel C. Vallejo, Mitchell D Creinin, Kelly T. Shannon, Gordon L. Mandell, Bupesh Kaul, Sivan Ramanathan

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Purpose: Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patent undergoing second trimester pregnancy termination. Clinical features: A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event. Conclusions: It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors.

Original languageEnglish (US)
Pages (from-to)139-144
Number of pages6
JournalCanadian Journal of Anesthesia
Issue number2
StatePublished - Feb 2004
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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