Right heart masses demonstrated by echocardiography in a patient with amniotic fluid embolism during labour

• DOI: 10.1111/aas.13006
• Publication Date: 2017-10-06T03:26:41Z
• Authors: K. H. Maack; K. Munk; K. Dahl; H. H. Jørgensen; A. Christiansen; R. B. Helmig
• Keywords: Amniotic fluid embolism

(Acta Anaesthesiol Scand. 2018;62(1):134–137) This case report described a patient in active labor after an oral misoprostol induction. While initial vital signs of the patient and fetus were normal, membranes unexpectedly ruptured and the patient became unresponsive. The maternal pulse was not detected in the operating room, so care providers delivered a live male infant by cesarean section to facilitate resuscitation of the patient. Ultrasound imaging showed the inferior vena cava contained large masses protruding into the right atrium, through the tricuspid valve and into the right ventricle. Cardiovascular circulation was restored 12 minutes after cardiovascular collapse, and epinephrine was administered to assist with circulation stabilization. Observation through echocardiography showed the masses gradually disappeared and the right ventricle became a normal size again. Because of a high volume of blood loss, care providers performed a red blood cell and plasma transfusion before the patient was transferred to the intensive care unit (ICU). Disseminated intravascular coagulation was suspected and later confirmed through blood analyses.