RESUMO
Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge. The purpose of this article is to share a care pathway developed by a multidisciplinary group at a community teaching hospital. Post hoc analysis of a complicated case of AFE resulted in development of this pathway, which addresses many of the major consequences of AFE. We offer this algorithm as a template for use by any institution willing to implement a clinical pathway to treat AFE. It is accompanied by the remarkable case outcome that prompted its development.
Assuntos
Algoritmos , Protocolos Clínicos , Parto Obstétrico/efeitos adversos , Embolia Amniótica/terapia , Adulto , Embolia Amniótica/etiologia , Feminino , Humanos , Corpo Clínico , Gravidez , Sistema de RegistrosAssuntos
Cesárea/métodos , Complemento C3a/imunologia , Embolia Amniótica , Lúpus Eritematoso Sistêmico , Complicações na Gravidez , Adulto , Ativação do Complemento , Embolia Amniótica/diagnóstico , Embolia Amniótica/etiologia , Embolia Amniótica/imunologia , Embolia Amniótica/terapia , Feminino , Ruptura Prematura de Membranas Fetais/cirurgia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Trabalho de Parto Prematuro/cirurgia , Gravidez , Complicações na Gravidez/imunologia , Complicações na Gravidez/fisiopatologia , Resultado do Tratamento , Contração UterinaRESUMO
La embolización de líquido amniótico es una de las condiciones más infrecuentes pero desvastadora que puede presentarse en embarazadas. La prevalencia se ha reportado de 1 en 80.000, con un alto índice de mortalidad (86%). El diagnóstico esta basado en uno o más de los 4 signos clínicos: colapso cardiovascular, dificultad respiratoria, coma y/o convulsiones y coagulopatía. Coagulación intravascular diseminada puede ocasionar pérdida visual bilateral en el grupo de sobrevivientes, por oclusión del sistema arterial retiniano u coroideo. Los sintomas visuales se presentan usualmente después del desarrollo de síntomas sistémicos; sin embargo, en el caso clínico que se expone a continuación la manifestación visual ocurrió simultaneamente con el desarrollo de las sistémicas. Por tanto, la pérdida visual bilateral en el contexto de los signos clínicos sistémicos expuestos, debe alertar al obstetra sobre la posibilidad de embolización de liquido amniótico.
Amniotic fluid embolism is one of the most devastating and infrequent condition known in pregnant women. The prevalence has been reportd as a 1 in 80.000 deliveries with high mortality rate, almost 86%. The diagnosis is based on one or more of the four symptoms and signs: cardiovascular collapse, respiratory distress, coma/seizures and/or coagulopathy. Disseminated intravascular coagulopathy can cause bilateral visual loss in the group of survivors by occlusion of the retinal artery and/or the choroid system. The visual manifestations appear usually after the development of systemic symptoms, but in the clinical case described below the visual symptoms occurred simultaneously to the development of systemic manifestations. Therefore, bilateral visual loss in the context of the systemic clinical signs exposed, should alert the obstetrician about the possibility of embolization of amniotic fluid.
Assuntos
Humanos , Adulto , Feminino , Gravidez , Coagulação Intravascular Disseminada/etiologia , Convulsões/etiologia , Corticosteroides/uso terapêutico , Embolia Amniótica/etiologia , Embolia Amniótica/mortalidade , Oclusão da Artéria Retiniana/complicações , Complicações na Gravidez/etiologia , Hemorragia Uterina/etiologia , Transtornos da Visão/etiologiaRESUMO
Gastrointestinal stromal tumors are the commonest stromal tumors of the digestive tract. Even though, the incidence is aproximately 10 to 20 cases per million people and year. More than 90% of these tumors take place in patients over 40, and the median age is 63. Its diagnosis during pregnancy is extremely rare. There are less than 10 cases reported in literature about gastrointestinal stromal tumors diagnosed during pregnancy. We describe the case of a patient who was diagnosed of gastrointestinal stromal tumor during her first pregnancy due to massive lower digestive bleeding and the fetus died. She underwent a small bowel resection and cesarean section delivery. Afterwards, she was controlled by obstetricians, digestive surgeons and oncologists. The following two pregnancies were normal, and six years since the diagnosis she is asymptomatic. Even if they are extremely rare tumors during pregnancy, it is very important knowing their diagnosis and multidisciplinary treatment; also very important is knowing their prognostic factors and the different possible treatments.