However, as a diagnosis of exclusion, the AFE triad is neither sensitive nor specific and should be considered once other diagnoses have been ruled out. Other symptoms include hypotension, frothing from the mouth, fetal heart rate abnormalities, loss of consciousness, bleeding, uterine atony, and seizure like activity. AFE is traditionally diagnosed clinically, in a woman early during labor with ruptured membranes, by a trio of symptoms: acute respiratory distress, cardiovascular collapse, and coagulopathy. Transesophageal echocardiography (TEE) can be used to determine cardiac dysfunction due to pulmonary hypertension but may not be widely available on obstetric units. This can be a challenge, as AFE is a diagnosis of exclusion with no universal pathological or serological markers. Įarly recognition and initiation of treatment of AFE are essential to increase the likelihood of patient survival. Conde-Agudelo and Romero found the percent total maternal deaths due to AFE to be 13.7%, slightly higher than the previous widely held 10%. AFE is the second leading direct cause of maternal death in the USA and Europe. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac.Īmniotic fluid embolism (AFE) is a rare, unpredictable, and potentially devastating complication of childbirth, in which amniotic fluid, fetal cells, hair, or other types of debris enter into the maternal pulmonary circulation, causing cardiovascular collapse. The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. ![]() The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. ![]() Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births.
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