A Case of Consumptive Coagulopathy Before Cardiopulmonary Failure in Amniotic Fluid Embolism and Review of Literature : A Perspective of the Latent Onset and Progression of Coagulopathy
Copyright © 2024, Oda et al..
Amniotic fluid embolism (AFE) induces cardiopulmonary insufficiency with consumptive coagulopathy. Previous studies reported that refractory coagulopathy has already advanced at the onset of maternal cardiovascular and/or respiratory symptoms. However, when the consumption of coagulation factors starts during the clinical course, AFE remains to be elucidated. We report an intrapartum AFE case of consumptive coagulopathy before dyspnea with hypotension developing during urgent cesarean delivery that was revealed by non-reassuring fetal heart rate tracing. The patient, a 42-year-old multiparous parturient, underwent induced labor after a premature rupture of membranes in week 39 of pregnancy. Coagulation screening was initially within the normal range. Fetal heart rate monitoring demonstrated bradycardia coincided with uterine tachysystole after three hours, which required urgent cesarean section with preoperative blood screening. The hemoglobin level was maintained at 129 g/L; however, the fibrinogen value reduced to 1.79 g/L with D-dimer elevation over 60 µg/mL. Ninety minutes later, she developed dyspnea with hypotension at suturing hysterotomy. At the end of surgery, her fibrinogen further decreased to below 0.3 g/L with prolonged prothrombin time. After vigorous intensive care, she was discharged without sequelae. Consumptive coagulopathy may initiate and progress before apparent cardiopulmonary symptoms in some AFE cases. Non-reassuring fetal heart rate tracing concomitant with abrupt uterine tachysystole and/or hypertonus may be an earlier time point for the detection and intervention of AFE-related coagulopathy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
Cureus - 16(2024), 3 vom: 27. März, Seite e55961 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Oda, Tomoaki [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 25.04.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.7759/cureus.55961 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370906977 |
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| 100 | 1 | |a Oda, Tomoaki |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A Case of Consumptive Coagulopathy Before Cardiopulmonary Failure in Amniotic Fluid Embolism and Review of Literature |b A Perspective of the Latent Onset and Progression of Coagulopathy |
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| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2024, Oda et al. | ||
| 520 | |a Amniotic fluid embolism (AFE) induces cardiopulmonary insufficiency with consumptive coagulopathy. Previous studies reported that refractory coagulopathy has already advanced at the onset of maternal cardiovascular and/or respiratory symptoms. However, when the consumption of coagulation factors starts during the clinical course, AFE remains to be elucidated. We report an intrapartum AFE case of consumptive coagulopathy before dyspnea with hypotension developing during urgent cesarean delivery that was revealed by non-reassuring fetal heart rate tracing. The patient, a 42-year-old multiparous parturient, underwent induced labor after a premature rupture of membranes in week 39 of pregnancy. Coagulation screening was initially within the normal range. Fetal heart rate monitoring demonstrated bradycardia coincided with uterine tachysystole after three hours, which required urgent cesarean section with preoperative blood screening. The hemoglobin level was maintained at 129 g/L; however, the fibrinogen value reduced to 1.79 g/L with D-dimer elevation over 60 µg/mL. Ninety minutes later, she developed dyspnea with hypotension at suturing hysterotomy. At the end of surgery, her fibrinogen further decreased to below 0.3 g/L with prolonged prothrombin time. After vigorous intensive care, she was discharged without sequelae. Consumptive coagulopathy may initiate and progress before apparent cardiopulmonary symptoms in some AFE cases. Non-reassuring fetal heart rate tracing concomitant with abrupt uterine tachysystole and/or hypertonus may be an earlier time point for the detection and intervention of AFE-related coagulopathy | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a amniotic fluid embolism (afe) | |
| 650 | 4 | |a consumptive coagulopathy | |
| 650 | 4 | |a critical care in obstetrics | |
| 650 | 4 | |a disseminated intravascular coagulation (dic) | |
| 650 | 4 | |a excessive fibrinolysis | |
| 650 | 4 | |a hemoglobin/fibrinogen ratio | |
| 650 | 4 | |a induction of labor (iol) | |
| 650 | 4 | |a non-reassuring fetal status | |
| 650 | 4 | |a pregnancy | |
| 650 | 4 | |a premature rupture of membranes | |
| 700 | 1 | |a Tamura, Naoaki |e verfasserin |4 aut | |
| 700 | 1 | |a Yata, Daisuke |e verfasserin |4 aut | |
| 700 | 1 | |a Oda-Kishimoto, Ayako |e verfasserin |4 aut | |
| 700 | 1 | |a Itoh, Toshiya |e verfasserin |4 aut | |
| 700 | 1 | |a Kubota, Naohiro |e verfasserin |4 aut | |
| 700 | 1 | |a Suzuki, Yasuyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Kanayama, Naohiro |e verfasserin |4 aut | |
| 700 | 1 | |a Itoh, Hiroaki |e verfasserin |4 aut | |
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