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Amniotic fluid embolism-associated coagulopathy: a single-center observational study
Lars Schröder1,2, Astrid Hellmund3, Ulrich Gembruch3
1Department of Obstetrics and Gynecology, Medical Faculty, University Hospital Cologne, Kerpener Straße 34, 50931, Cologne, Germany. lars_schroed@gmx.net.
Archives of Gynecology and Obstetrics
|March 12, 2020
Summary
Amniotic fluid embolism (AFE) is a rare obstetric emergency. This study suggests hyperfibrinolysis contributes to AFE coagulopathy, recommending early tranexamic acid and blood product transfusion for better maternal and neonatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Critical Care Medicine
Background:
- Amniotic fluid embolism (AFE) is a rare obstetric emergency with high maternal mortality, characterized by cardiovascular collapse, neurological symptoms, and coagulopathy.
- Current treatment protocols for AFE-associated coagulopathy primarily focus on consumptive coagulopathy.
Observation:
- Serial hemostaseological parameters were analyzed in three consecutive AFE cases.
- All mothers and neonates survived without major sequelae.
- Key findings included disproportionately low fibrinogen and factor V levels, and markedly elevated D-dimers, with only minor reductions in platelets and antithrombin.
Findings:
- The observed hemostatic profile suggests significant hyperfibrinolysis plays a role in AFE-associated coagulopathy.
- Results indicate that traditional markers of consumptive coagulopathy may not fully capture the hemostatic derangements in AFE.
Implications:
- A revised treatment algorithm for AFE is proposed, emphasizing early administration of tranexamic acid.
- The algorithm includes transfusion of red blood cells and fresh frozen plasma, with fibrinogen supplementation if needed to achieve hemostasis.
- This approach aims to improve maternal and neonatal survival rates in AFE cases.
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