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Amniotic Fluid Embolism

Donald A. Nickerson, M.D.
JAMA. 1961;178(7):758-759. doi:10.1001/jama.1961.73040460028017.
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ONE OF THE COMMON CAUSES of obstetrical death during labor, delivery, or the immediate postpartum period, is the result of sudden introduction of amniotic fluid into the maternal circulation. This catastrophe is manifested clinically by respiratory distress, cyanosis, shock, and coma. In some of these patients who survive the initial period, afibrinogenemia with severe, uncontrollable bleeding may occur. These patients are usually multipara in the older age group. The prenatal course is uneventful and no complications are noted before labor begins. In some, pregnancy has lasted beyond the expected date of confinement and in others the fetus may be larger than normal.

Characteristically, the uterine contractions during labor are reported as being hard, violent, tetanoid, or tumultuous. The first symptom is usually that of a subjective chilliness, with hyperpnea and cyanosis. The blood pressure drops to shock levels. In addition there are often convulsions, either clonic or tonic in nature,


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