Advertisement

A description of the coagulopathy characteristics in amniotic fluid embolism: a case report

      Highlights

      • Amniotic fluid embolism (AFE) coagulopathy features are incompletely understood.
      • Clotting factors, thrombin generation, fibrinogen, and D-dimers were measured.
      • Acute hypofibrinogenaemia, dysfibrinogenaemia and massive fibrinolysis were seen.
      • Clotting factor levels remained haemostatic and thrombin generation was preserved.
      • Treatment of hyperfibrinolysis and hypofibrinogenaemia may improve AFE outcome.

      Abstract

      Amniotic fluid embolism is frequently associated with coagulopathy. However, the exact nature and evolution of the bleeding disorder is incompletely understood. We report a case of clinically diagnosed amniotic fluid embolism associated with major haemorrhage and coagulopathy. We measured sequential levels of all individual clotting factors, thrombin generation, fibrinogen, and D-dimer levels over the course of the event, beginning shortly after the patient’s initial collapse and during the subsequent resuscitation, to identify the specific abnormalities of coagulation from stored blood samples. A better understanding of amniotic fluid embolism and the associated coagulopathy is an important area of research to inform targeted treatment of the coagulopathy and improve outcomes for patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. UKOSS. Case definition for UKOSS surveillance. https://www.npeu.ox.ac.uk/ukoss/current-surveillance/amf/; 2020. Accessed December 1, 2020.

        • Wada H.
        • Thachil J.
        • Di Nisio M.
        • et al.
        Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of the recommendations from three guidelines.
        J Thromb Haemost. 2013; 11: 761-767https://doi.org/10.1111/jth.12155
        • Metodiev Y.
        • Ramasamy P.
        • Tuffnell D.
        Amniotic fluid embolism.
        BJA Educ. 2018; 18: 234-238https://doi.org/10.1016/j.bjae.2018.05.002
        • Sultan P.
        • Seligman K.
        • Carvalho B.
        Amniotic fluid embolism: update and review.
        Curr Opin Anesthesiol. 2016; 29: 288-296https://doi.org/10.1097/ACO.0000000000000328
        • Lilley G.
        • Burkett-St-Laurent D.
        • Precious E.
        • et al.
        Measurement of blood loss during postpartum haemorrhage.
        Int J Obstet Anesth. 2015; 24: 8-14https://doi.org/10.1016/j.ijoa.2014.07.009
        • Collins P.W.
        • Macchiavello L.
        • Lewis S.
        • et al.
        Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls.
        Br J Haematol. 2006; 135: 220-227https://doi.org/10.1111/j.1365-2141.2006.06281.x
        • Chowdhury P.
        • Saayman A.G.
        • Paulus U.
        • Findlay G.P.
        • Collins P.W.
        Efficacy of standard dose and 30ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients.
        Br J Haematol. 2004; 125: 69-73https://doi.org/10.1111/j.1365-2141.2004.04868.x
        • Tanaka H.
        • Katsuragi S.
        • Osato K.
        • et al.
        Value of fibrinogen in cases of maternal death related to amniotic fluid embolism.
        J Matern Fetal Neonatal Med. 2017; 30: 2940-2943https://doi.org/10.1080/14767058.2016.1269166
        • Umazume T.
        • Morikawa M.
        • Yamada T.
        • Akaishi R.
        • Koyama T.
        • Minakami H.
        Protein S deficiency present in a pregnant woman with dyspnea, abdominal pains, restlessness, agitation and hypofibrinogenemia.
        Clin Case Rep. 2015; 3: 213-216https://doi.org/10.1002/ccr3.200
        • Schröder L.
        • Hellmund A.
        • Gembruch U.
        • Merz W.
        Amniotic fluid embolism-associated coagulopathy: a single-center observational study.
        Arch Gynaecol Obstet. 2020; 301: 923-929https://doi.org/10.1007/s00404-020-05466-w
        • Hell L.
        • Wisgrill L.
        • Ay C.
        • et al.
        Procoagulant extracellular vesicles in amniotic fluid.
        Transl Res. 2017; 184: 12-20https://doi.org/10.1016/j.trsl.2017.01.003
        • Loughran J.
        • Kitchen T.
        • Sindhakar S.
        • Ashraf M.
        • Awad M.
        • Kealaher E.
        Rotational thromboelastometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism.
        Int J Obstet Anesth. 2019; 38: 127-130https://doi.org/10.1016/j.ijoa.2018.09.001
        • Harnett M.
        • Hepner D.
        • Datta S.
        • Kodali B.
        Effect of amniotic fluid on coagulation and platelet function in pregnancy: an evaluation using thromboelastography.
        Anaesthesia. 2005; 60: 1068-1072https://doi.org/10.1111/j.1365-2044.2005.04373.x
        • Fitzpatrick K.
        • van den Akker T.
        • Bloemenkamp K.
        • et al.
        Risk factors, management, and outcomes of amniotic fluid embolism: a multicountry, population-based cohort and nested case-control study.
        PLoS Med. 2019; 16: e1002962