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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Amniotic fluid embolism remains an enigmatic and often lethal condition. The pathophysiology is complex, however, from a clinical standpoint. Right or, more commonly, left heart failure is the dominant physiologic aberration. Disseminated intravascular coagulation is often present. The detection of squamous cells in the central circulation of living patients can no longer be considered pathognomonic for this condition.
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PMID:Amniotic fluid embolism. 174 6

The syndrome of coagulation defects in obstetrics was detected as cause for obstetrical hemorrhage during the 50 years. Some of the etiologic factors like the dead fetus syndrome or the salting out syndrome have vanished. Amniotic fluid embolism is the only syndrome which is clearly associated with disseminated intravascular coagulation. This connection between premature separation is less clear. One concept assumes that the plasma fibrinogen concentration is low because it is consumed in the retroplacental hematoma. Heparin treatment can be fatal if DIC is mistaken with a "loss coagulopathy", which is at present mostly responsible for coagulation defects and obstetrical hemorrhage. This indicates a change in pattern of disease which is due to a better pathophysiologic understanding.
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PMID:[Acute blood coagulation disorders in pregnancy--changing patterns in the disease picture]. 349 59

Four probable cases of amniotic fluid embolism (AFE) are reviewed. The outcome appeared to be determined by the severity of the insult, and possibly the gestation of the pregnancy, rather than the management of the AFE. Two cases occurred during early labour; neither patient recovered consciousness. One died two weeks later and the other suffered severe permanent cerebral damage. The other two cases occurred during dilatation and curettage, one for therapeutic abortion at fourteen weeks gestation and the other for missed abortion at twenty weeks gestation. Both patients made full recoveries. Disseminated intravascular coagulation (DIC) was a feature of all four cases. In the patients in labour it occurred almost immediately. In those undergoing dilatation and curettage it occurred after the patients had apparently recovered but were under observation in the intensive care unit. Amniotic fluid embolism can occur during an apparently uneventful labour. It should also be suspected when unexplained collapse occurs during second trimester dilatation and curettage. Because severe DIC may follow, such patients should be transferred immediately to a centre with full haemotology services.
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PMID:Amniotic fluid embolism: a report of four probable cases. 371 41

Amniotic fluid embolism is a catastrophic event of the intra- and early postpartum period which may also be seen with cesarean delivery and during abortions. Presenting symptomatology includes respiratory distress with cyanosis, shock, and possibly tonic-clonic seizures. DIC frequently occurs. The pathogenesis may include entry of amniotic fluid through lacerations or ruptures of the uterus or cervix, through endocervical veins and through abnormal uteroplacental sites, such as with placental abruption, placenta previa, or placenta accreta. Amniotic fluid probably causes cardiovascular-respiratory symptoms by pulmonary vascular obstruction and through a vasoactive substance causing pulmonary vascular constriction. The lethality of amniotic fluid may be enhanced by a high particulate content or meconium staining. The diagnosis of amniotic fluid embolism may be made ante mortem by demonstrating amniotic fluid debris in central blood samples or expectorated sputum. Postmortem diagnosis often requires meticulous examination of the pulmonary microvasculature with the utilization of special stains. Treatment is directed towards symptoms of shock, arterial hypoxemia, and DIC. Acute renal failure may complicate the picture after shock. If the patient survives the embolic and coagulative problems, recovery is usually complete without long-term sequelae.
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PMID:Amniotic fluid embolism. Three case reports with a review of the literature. 402 76

Amniotic fluid embolism following transabdominal amniocentesis is a very rare and mostly fatal event. A case history is presented with the characteristic clinical findings in addition to disseminated intravascular coagulation immediately following an amniocentesis to assess fetal lung maturity.
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PMID:Amniotic fluid embolism after transabdominal amniocentesis. 662 16

Amniotic fluid embolism is an important complication of pregnancy with high mortality. The diagnosis of amniotic fluid embolism is generally made postmortem and rests upon the histological demonstration of amniotic fluid debris, including foetal epithelial squames and hair, in the pulmonary vasculature. We have made the diagnosis of amniotic fluid embolism in two patients by detection of the amniotic fluid debris in the blood vessels of the cervix in their hysterectomy specimens. These two patients presented with profuse primary postpartum haemorrhage and evidence of disseminated intravascular coagulation after uneventful deliveries. Amniotic fluid debris were only demonstrated in the blood vessels of the cervix but not in the corpus. This observation emphasizes the importance of a thorough histological examination of the cervix in cases of suspected amniotic fluid embolism.
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PMID:The importance of extensive sampling and examination of cervix in suspected cases of amniotic fluid embolism. 809 86

Amniotic fluid embolism is a rare complication of pregnancy, which accounts for about 10% of all maternal deaths. A case of acute embolic episode occurred during labor in a 36-year-old patient with spontaneous rupture of membranes is described. Caesarean section was performed immediately, followed by hysterectomy; the baby survived but the mother died because of DIC and cardiorespiratory arrest.
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PMID:[Amniotic fluid embolism in trial of labor. A case report]. 930 83

A 33-year-old woman, gravida IV, para III with unexplained polyhydramnios was admitted to give birth at 29 weeks of pregnancy. Directly after the spontaneous breaking of the membranes, asystolia occurred. Following emergency resuscitation the sinus rhythm returned. Upon the relaparotomy due to a large filling requirement and increasing abdomen size, 'crush' lesions to the spleen and liver were visible; following this a splenectomy was carried out and tampons applied to the liver. After seven months the patient had slight residual symptoms; three weeks after his birth her son was transferred in good condition to another hospital. Amniotic fluid embolism is a rare complication of pregnancy with often serious complications for mother and child. The diagnosis is based on the clinical symptoms of cardiac arrest or sudden profound shock, acute respiratory failure, and/or disseminated intravascular coagulation, occurring in most cases during or soon after delivery, in the absence of an alternative cause (in particular primary cardiopulmonary causes). If the clinical picture deviates from the expected post-resuscitation course alternative diagnoses or resuscitation injuries must be considered.
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PMID:[Complicated but successful resuscitation after amniotic fluid embolism]. 1133 60

A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.
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PMID:Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism. 1141 96

Amniotic fluid embolism (AFE) is characterized by the passage of amniotic fluid (AF) into the maternal circulation during or just after childbirth. AFE is a rare disorder occurring in 1/8,000 to 1/80,000 deliveries but with a maternal morbidity ranging from 26% in a recent report to 86% in earlier ones. In patients who survive, AFE may affect coagulation resulting in severe bleeding. While disseminated intravascular coagulation (DIC) is usually seen in such cases, we reported a case of AFE in which the hemostatic abnormalities were compatible with primary fibrinogenolysis rather than with DIC.
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PMID:Amniotic fluid embolism with haemostasis complications: primary fibrinogenolysis or disseminated intravascular coagulation? 1517 Mar 98


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