Rapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism

We describe a case of amniotic fluid embolism presenting as cardiovascular collapse during labour. After initial resuscitation and emergency caesarean section, the patient was transferred to the intensive care unit with profound hypoxaemia, a high inotropic drug requirement and severe coagulopathy. A transoesophageal echocardiogram demonstrated acute right ventricular overload, severe pulmonary artery hypertension and marked diastolic dysfunction of the left ventricle secondary to a dilated right ventricle. The introduction of nitric oxide at 40 ppm produced a dramatic improvement in her cardiorespiratory status. Mother and baby both survived with no apparent long term sequelae.