Other relevant laboratory parameters were: bilirubin 0.3 mg/dL (range, 0.2 to 1.0), aspartate aminotransferase 21 U/L (range, 2 to 40), alanine aminotransferase 11 U/L (range, 4 to 49), gamma-glutamyl transferase 11 U/L (range, 2 to 38), and alkaline phosphatase 143 U/L (range, 90 to 360). Urgent laboratory tests showed alterations as follows: white blood cells 24.40 × 1,000/μL, red blood cells 2.68 million/μL, hemoglobin 7.1 g/dL, hematocrit 22.2%, and platelets 147 × 1,000 μL, international normalized ratio (INR) 1.59, activated partial thromboplastin time ratio 2.18, fibrinogen 178 mg/L, C-reactive protein 33.80 mg/dL, and serum procalcitonin 64.60 mg/dL. Physical examination showed generalized abdominal tenderness, marked in the right hypochondrium and right flank, with a positive Blumberg sign in these quadrants. Three days after delivery, patient came to Emergency Department complaining of fever (body temperature 38.1☌, blood pressure 135/88 mmHg, heart rate 82 beats/min, and respiratory rate 20 breaths/min) and widespread acute abdominal pain, prevalent in the right abdominal quadrants, in absence of other symptoms and signs (nausea, vomiting, change in bowel habits). Mother and newborn were discharged on the second day, being both in good general clinical conditions. She had a negative medical and surgical history, without previous surgery, hemostatic disorders or spontaneous bleeding. She gave birth to a 3,176 g healthy baby boy. We introduce a very rare case of atypical AFE presentation with hepatic involvement (hepatic abscess), colic involvement (stenosing inflammation) and DIC, in the absence of classical symptoms and signs of cardiovascular and respiratory impairment, whose diagnosis has only been obtained by histopathology of surgical specimens.Ī 27-year-old Moroccan woman presented to Gynecology and Obstetrics Unit for caesarean delivery due to umbilical cord prolapse and membrane breakdown at 40th week. The diagnosis of such forms is often underestimated. However, AFE can show very variable atypical forms, whose symptoms and signs differ depending on the concerned viscera and degree of involvement. This triad is secondary to hemodynamic collapse, respiratory compromise and disseminated intravascular coagulation (DIC), due to amniotic fluid entering maternal circulation. Typical AFE clinical presentation includes a sudden triad of hypoxia, hypotension and coagulopathy. Only recently, uniform diagnostic criteria have been introduced to search for AFE cases, especially in its classical form.
In the past decades, correct diagnosis has turned out difficult and different according to diagnostic criteria adopted.
#AMNIOTIC FLUID IN TOILET MANUAL#
AFE has also been detected after trauma, cervical laceration, abortion, amniocentesis and manual removal of the placenta. Although on very few occasions, this potentially deadly condition affects women during labor (70%), vaginal delivery (11%), cesarean delivery (19%), or postpartum (rarely). Amniotic fluid embolism (AFE) or "anaphylactoid syndrome of pregnancy" was first described by Ricardo J.
0 kommentar(er)
