No abstract available.
Amniotic Fluid* ; Colon* ; Embolism, Amniotic Fluid* ; Female ; Liver* ; Pregnancy

OBJECTIVE: Reviewing indications and characteristics of obstetric patients admitted to the intensive care unit (ICU) of a tertiary care center, comparing those patients by time period and place of delivery, and to verify clinical utility of acute physiology and chronic health evaluation (APACHE) II score in ICU-admitted women. METHODS: Retrospective analyses were carried out for parturients admitted to the ICU of our institution from 1994 to 2015. Clinical characteristics were compared between time period (period 1: 1994–2004; period 2: 2005–2015) and place of delivery (our institution and local hospitals). Receiver operating characteristic (ROC) curve analysis was used to evaluate the usefulness of APACHE II score to predict maternal mortality. RESULTS: During 22-year period, 176 women required ICU admission, showing the incidence of 2.2 per 1,000 deliveries. The most common reason for ICU admission was postpartum hemorrhage (56.3%), followed by hypertensive disorders (19.3%), sepsis (3.4%), and pulmonary and amniotic fluid embolism (2.3%). Period 2 showed older maternal age (32.7±4.8 vs. 30.8±4.4 years, P=0.006, higher embolization rate (26.4% vs.1.2%, P < 0.001), and lower hysterectomy rate (30.8% vs. 49.4%, P=0.012). Cases from local hospitals showed significantly higher proportion of postpartum hemorrhage (84.5% vs. 42.2%, P < 0.001). Overall maternal death occurred in 5.1% (9/176) including 6 direct maternal deaths. The APACHE II score showed area under the ROC curve of 0.813 (confidence interval [CI], 0.607–1.000) for prediction of maternal mortality. CONCLUSION: The incidence of obstetric ICU admission was 2.2 per 1,000 deliveries and the most common reason was postpartum hemorrhage followed by hypertensive disorders. APACHE II score could be used to predict mortality in obstetric ICU admission.
APACHE ; Critical Care* ; Embolism, Amniotic Fluid ; Female ; Humans ; Hysterectomy ; Incidence ; Intensive Care Units* ; Maternal Age ; Maternal Death ; Maternal Mortality ; Mortality ; Postpartum Hemorrhage ; Pregnancy ; Retrospective Studies ; ROC Curve ; Sepsis ; Tertiary Care Centers* ; Tertiary Healthcare*

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
Adult ; Amniotic Fluid* ; Anaphylaxis ; Anoxia ; Cardiopulmonary Bypass ; Cesarean Section ; Cognition ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Peripartum Period ; Pregnancy ; Pregnant Women ; Pulmonary Circulation ; Shock

No abstract available.
Amniotic Fluid* ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Pregnancy

No abstract available.
Amniotic Fluid* ; Embolism, Air* ; Embolism, Amniotic Fluid* ; Female ; Pregnancy

No abstract available.
Amniotic Fluid ; Embolism, Air ; Embolism, Amniotic Fluid ; Female ; Pregnancy

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
Adult ; Amniotic Fluid ; Anaphylaxis ; Anoxia ; Cardiopulmonary Bypass ; Cesarean Section ; Cognition ; Embolism, Amniotic Fluid ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Peripartum Period ; Pregnancy ; Pregnant Women ; Pulmonary Circulation ; Shock

No abstract available.
Amniotic Fluid ; Embolism, Amniotic Fluid ; Extracorporeal Membrane Oxygenation ; Female ; Pregnancy

Amniotic fluid embolism (AFE) is a rare but potentially fatal complication that occurs acutely during pregnancy or within 12 h of delivery. The management of AFE focuses initially on supportive measures for cardiopulmonary stabilization. Extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical treatment in order to prevent additional hypoxia and subsequent organ failure. We present a 41-year-old woman with clinical AFE who developed acute respiratory distress syndrome and was treated successfully with extracorporeal membrane oxygenation.
Adult ; Amniotic Fluid* ; Anoxia ; Embolism ; Embolism, Amniotic Fluid* ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Pregnancy ; Respiratory Distress Syndrome, Adult

Cardiac arrest one day after cesarean section is extremely rare. Obstetrical clinicians have low experience to these serious situations necessitating immediate first aid and knowledge of its differential diagnosis. A 33-year-old woman underwent elective repeat cesarean section at 38 weeks of gestation under spinal anesthesia. The patient underwent uneventful course on that day. Loss of consciousness occurred one day after cesarean section during her first ambulation. Immediate cardiac compression was performed and eventually resulted in good recovery of her heartbeat. Her condition was suitable disseminated intravascular coagulation (DIC). She developed acute ischemic pancreatitis after cardiac arrest. We describe the consideration of amniotic fluid embolism with DIC as most appropriate in this case. To our knowledge, our case is one of the most dangerous conditions after the cesarean section. Here, we report our case with a review of literatures.
Adult ; Anesthesia, Spinal ; Cesarean Section ; Cesarean Section, Repeat ; Dacarbazine ; Death, Sudden, Cardiac* ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid ; Female ; First Aid ; Heart Arrest ; Humans ; Pancreatitis ; Pregnancy ; Pulmonary Embolism* ; Unconsciousness ; Walking