Thromboelastometry-Guided Therapy of Fulminant Coagulopathy during C-Section and Amniotic Fluid Embolism

Case Report

Austin Cardio & Cardiovasc Case Rep. 2022; 7(1): 1045.

Thromboelastometry-Guided Therapy of Fulminant Coagulopathy during C-Section and Amniotic Fluid Embolism

Weiss R¹*, Von Groote TC¹, Schäfer SD² and Keller M¹

¹Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany

²Department of Gynecology and Obstetrics, University Hospital Münster, Germany

*Corresponding author: Weiss R, Department for Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Complex A1, 48149 Münster–Germany

Received: June 24, 2022; Accepted: July 26, 2022; Published: August 02, 2022

Abstract

This article describes the emergency case of a mid-thirty-year-old pregnant woman who suffered the rare obstetric complication of an amniotic fluid embolism, resulting in fulminant Disseminated Intravascular Coagulopathy (DIC) and shock. DIC was diagnosed with Thromboelastometry (TEM) and therapy was consequently guided by TEM. Thromboelastometry is a viscoelastic hemostatic assay that enables assessment of different aspects of whole blood clot formation under shear stress. This technique is increasingly used in anesthesia and critical care to guide hemostatic therapy. This report underlines the importance of TEM-monitoring of hemostatic complications such as DIC.

Keywords: Guided therapy; Shock; ROTEM; Disseminated intravascular coagulopathy; Caesarean section

Case Presentation

Introduction

In 2000, the United Nations defined the Millennium Development Goals to improve global living conditions. Goal five aims for an improvement in maternal health care with a 75% reduction in the maternal mortality rate within two decades. Since then, rates of maternal survival have improved significantly (50% reduction in maternal mortality since 1990), with the majority being achieved after 2000. Nevertheless, around 300,000 mothers worldwide continue to die each year as a result of childbirth. This is around 820 dead mothers per day [1]. To improve this situation, interdisciplinary cooperation between, anesthesiological and gynaecological teams is essential. Especially in complex and challenging emergency cases, implementation of innovative technologies yields major opportunities to enable more directed therapies (precision medicine).

In 2014, the World Health Organization (WHO) published a comprehensive global analysis of the leading causes of maternal death (Table 1) [2]. Regardless of region, hemorrhage was the leading cause of death, followed by embolism.

Citation: Weiss R, Von Groote TC, Schäfer SD and Keller M. Thromboelastometry-Guided Therapy of Fulminant Coagulopathy during C-Section and Amniotic Fluid Embolism. Austin Cardio & Cardiovasc Case Rep. 2022; 7(1): 1045.