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Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization

[Deux cas d’hémorragie secondaire à une embolie amniotique traités par une embolisation de l’artère utérine]

From the Department of Anesthesia, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.

Address correspondence to: Dr. Eric Goldszmidt, Department of Anesthesia, Mount Sinai Hospital, 600 University Avenue, Suite 1514, Toronto, Ontario M5G 1X5, Canada. Phone: 416-586-5270; Fax: 416-586-8664; E-mail: e.goldszmidt{at}utoronto.ca

Purpose: To describe the anesthetic management of two cases of amniotic fluid embolus (AFE) and disseminated intravascular coagulation (DIC) who underwent bilateral uterine artery embolization to control their postpartum hemorrhage.

Clinical features: We report the clinical course and management of two women who suffered sudden cardiorespiratory events during labour. The first patient had a cardiac arrest whereas the second developed respiratory failure and altered neurological status. They were diagnosed as having had an AFE. Both of these events were accompanied by severe postpartum hemorrhage and DIC. They suffered prolonged bleeding and received massive transfusions. Successful management of hemorrhage was optimized by uterine artery embolization, thus avoiding ongoing problems with bleeding and possible hysterectomy. The role of uterine artery embolization is described, along with its advantages and anesthetic considerations.

Conclusion: Women with severe postpartum hemorrhage, with or without DIC, should be considered for uterine artery embolization.

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