An Amniotic Fluid Embolism Survival Story

Background: This was a full term laboring patient with a history of gestational diabetes, no pulmonary disease history.   Until the insult, the  labor was uncomplicated and the fetal monitor tracing was a category one. Luckily the Labor and Delivery R.N was at the bedside charting when the patient first began to cough. The patient had an epidural and pitocin was in use.

Case: The patient suddenly began to cough, and could not stop.  It appeared as if the patient was choking.  A prolonged fetal heart rate deceleration was noted, maternal oxygen saturation and maternal heart rate also dropped. Additional nurses and an anestheologist were called to the bedside stat.  Mother's radial pulse became nonpalpable, oxygen saturation finger clip connected to electronic fetal monitor did not registered a pulse or an O2 sat. reading however an apical pulse via stethoscope was still heard.  Patient was moved quickly to the labor and delivery operating room where she was rapidly  intubated  by the anestheologist. Respiratory status stabilized after intubation.  A stat C-Section was performed and a live newborn was delivered and handed to  awaiting NICU staff.  Bleeding during surgery appeared to be slightly increased.  The circulating nurse looked under OR drape to check lochia flow and discovered the patient was bleeding profusely from the vagina.  Urine output was minimal.  An arterial line and a central line was quickly placed by the anestheologist as it appeared the patient had develped Disseminated Intravascular Coagulation.  At the same time, the circulating nurse called the blood bank to initiate the Obstetrical Rapid Blood Transfusion protocol. The blood transfusion protocol is similar to an ER trauma blood transfusion protocol.  The blood bank follows the  protocol by cross matching and thawing several units of blood products at one time according to an established guidline.  Equipment utilized that Labor and Delivery nurses are familiar with included a hemorrhage cart, an A line cart, an ISTAT with various cartriges, a rapid blood transfuser and a crash cart.  Fortunately, the patient never went into cardiac arrest.   The patient did receive multiple units of blood very quickly.  She was transferred to the Intensive Care Unit immediately after the cesarean section where she remained for at least 24 hours.

Conclusion: Patient and newborn were discharged in stable condition on postpartum day six.   

Keywords: amniotic fluid embolism, disseminated intravascular coagulation, rapid blood transfusion protocol