Amniotic fluid embolism (AEF) is a rare obstetric complication and can be said to be an obstetrician’s nightmare. What's scary about it is its poor predictability and rapid onset and development. Although the incidence rate is low, the fatality rate is high. Once suspected, you must race against time for rescue!
Recently, Jining First People's Hospital Department of Critical Care Medicine, Obstetrics, Department of Anesthesia and Surgery, Department of Interventional Radiology and other multi-disciplinary collaborations successfully treated Zoucheng emergency maternal transfer to a 34-year-old critically ill mother who suffered amniotic fluid embolism Back from the brink of death.
Cardiac arrest three times
ICU Life and death rescue
A few days ago, Ms. Sun, a pregnant woman who lives in Zoucheng, suffered an amniotic fluid embolism during delivery. She suffered unconsciousness and postpartum hemorrhage. Her condition worsened sharply and she was urgently transferred to Jining City No. 1 hospital overnight. A People's Hospital conducted rescue operations. "The patient suffered cardiac arrest when he came to the hospital. At that time, breathing and circulation were difficult to maintain. His condition was extremely critical and he was at the critical moment of life and death." Su Long, deputy director of the Department of Critical Care Medicine of Jining First People's Hospital, led a team to perform emergency cardiopulmonary resuscitation. Open intravenous access, tracheal intubation, oxygen administration...rescue work began immediately. At the same time, the hospital immediately launched the emergency plan for amniotic fluid embolism rescue, opened a "green channel", and a life-and-death rescue began. Time is life. Under the overall coordination of the Medical Department, multi-disciplinary consultations in the hospital were urgently organized, and a hospital-level rescue expert group was established as soon as possible. The dean and business dean personally served as the leaders of the leading group and expert group, establishing a "green rescue" Passage", a life-and-death rescue begins.
Considering that the mother had disseminated intravascular coagulation (DIC) and refractory postpartum hemorrhage, in order to save the life of the young mother, the rescue team decided to take a risk and perform interventional embolization surgery.
On the operating table, the medical staff cooperated skillfully, operated carefully, and strictly controlled bleeding. Under the operating table, the rescue team performed their duties and made progress in an orderly manner. However, the treatment process was extremely dangerous, and the patient suffered two cardiac arrests. finally. With the sincere cooperation of multi-disciplinary teams including the Department of Critical Care Medicine, Obstetrics, Department of Anesthesia and Surgery, and the Department of Interventional Radiology, through active and efficient cardiopulmonary resuscitation, respiratory and circulatory support, interventional embolization and hemostasis and other rescue treatments, the patient suffered from bleeding after more than four thrilling hours of rescue. The situation was finally under effective control.
Multidisciplinary joint operations
A mother with amniotic fluid embolism is out of danger
Although the patient's autonomic heart rhythm has recovered, she is also complicated by symptoms such as severe pulmonary edema, respiratory failure, and renal failure. Oxygenation is difficult to maintain. In order to maintain adequate oxygen supply, frequent Through multidisciplinary consultation in the hospital, the ECMO team from the Department of Critical Care Medicine successfully provided extracorporeal membrane lung support and provided top-level life support means. After 6 days of careful treatment and successful withdrawal from ECMO, the patient's condition gradually stabilized.
At present, with the multidisciplinary consultation and joint efforts of the hospital, the patient's platelet number has gradually increased to normal, coagulation function and anemia have gradually improved, his heart function has returned to normal, his consciousness has become clear, and he has recovered well. He is now able to have sex. bed walking. It is understood that amniotic fluid embolism occurs when amniotic fluid suddenly enters the maternal blood circulation during delivery, causing acute pulmonary embolism, anaphylactic shock, disseminated intravascular coagulation, or sudden death. It is a rare and extremely critical complication in obstetrics.. The subsequent DIC, severe shock and multiple organ failure are very difficult to deal with clinically, develop extremely rapidly, have a relatively high mortality rate, and are very difficult to treat. The global incidence of amniotic fluid embolism is 1.9-7.7/100,000, and the highest mortality rate is 86%.
"Amniotic fluid embolism often occurs urgently, and the timing of treatment is very important." Han Yingjie, director of the obstetrics department of Jining First People's Hospital, said that timely diagnosis and treatment and close cooperation of the rescue team were crucial to successfully rescue this woman with amniotic fluid embolism. Jining First People's Hospital adheres to the collaborative operation of a multidisciplinary expert team and has accumulated rich practical experience in rescuing high-risk pregnant women, which provides strong technical support for the successful treatment of pregnant women.
"The incidence of this disease is very low. I have been practicing for more than 20 years and have rarely seen it, let alone such a dangerous amniotic fluid embolism." In Su Long's view, the success of this rescue is as good as the emergency response of Jining First People's Hospital. Critical illness emergency treatment capabilities and teamwork are inseparable. Quick response, accurate judgment, and team cooperation are the keys to the success of this rescue.
Source: Jining First People’s Hospital Health Paradise
Text and pictures: Li Qian Qiao Meng
