Emboli Air Ketuban
Abstract
Emboli cairan amnion (EAK) adalah komplikasi kehamilan yang jarang namun membawa angka mortalitas yang tinggi. Patogenesis yang tepat dari kondisi ini masih belum diketahui. Emboli air ketuban (EAK) atau amniotic fluid embolism (AFE) atau anaphylactoid syndrome of pregnancy adalah salah satu komplikasi kehamilan yang paling membahayakan. Cairan ketuban, debris fetal diduga menyebabkan kolaps kardiovaskular dengan cara memicu reaksi imun/anafilaktoid maternal. Patofisiologi EAK hingga kini masih belum jelas tetapi diduga melibatkan kaskade immunologis. Kematian maternal bisa terjadi karena cardiac arrest mendadak, perdarahan karena koagulopati, dan kegagalan organ multipel dengan acute respiratory distess syndrome (ARDS). Gejala dan tanda EAK antara lain dispnea akut, batuk, hipotensi, sianosis, bradikardia fetal, ensefalopati, hipertensi pulmoner akut, koagulopati, dan sebagainya. Diagnosis EAK adalah bersifat klinis dan ditegakkan setelah menyingkirkan kemungkinan penyebab lain. Penatalaksanaan bersifat suportif dan memerlukan persalinan janin jika diperlukan, support respiratorik, dan support hemodinamik. Prognosis maternal setelah EAK masih sangat buruk meski tingkat survival janin sekitar 70%. Pasien dengan EAK paling baik dikelola di unit perawatan kritis oleh tim multidisiplin dan dengan manajemen supportif.
Amniotic Fluid Embolism
Abstract
Amniotic fluid embolism (AFE) is a rare complication of pregnancy carrying a high mortality rate. The exact pathogenesis of the condition is still not known. Amniotic fluid embolism (AFE) or anaphylactoid syndrome of pregnancy is one of the most dangerous pregnancy complications. Amniotic fluid, fetal debris is thought to cause cardiovascular collapse by triggering a maternal immune / maternal anaphylactoid reaction. The pathophysiology of AFE remains unclear but is thought to involve an immunological cascade. Maternal deaths may occur due to sudden cardiac arrest, bleeding due to coagulopathy, and multiple organ failure with ARDS. AFE symptoms and signs include acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy. Management is supportive, respiratory support, and haemodynamic support. The maternal prognosis is very poor even though the survival rate of the fetus is about 70%. Patients with AFE are best managed in a critical care unit by a multidisciplinary team and management is largely supportive
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References
Balinger KJ, Chu Lam MT, Hon HH, Stawicki SP, Anasti JN. Amniotic fluid embolism: despite progress, challenges remain. Curr Opin Obstet Gynecol. 2015 Dec;27(6):398–405.
Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol. 2009 Nov;201(5):445.e1-445.e13.
Girendra Sadera, Bharathram Vasudevan.Amniotic Fluid Embolism. Journal of Obstetric Anaesthesia and Critical Care / Jan-Jun 2015 / Vol 5:3–8.
Anderson JA, Laloë P, Tuffnell DJ. Amniotic fluid embolism (anaphylactoid syndrome of pregnancy). In: Clark V, Van de Velde M, Fernando R, editors. Oxford textbook of obstetric anaesthesia. S.l.: Oxford Univ Press; 2016.
Tamura N, Farhana M, Oda T, Itoh H, Kanayama N. Amniotic fluid embolism: Pathophysiology from the perspective of pathology: The pathology of AFE. J Obstet Gynaecol Res. 2017 Apr;43(4):627–32.
Clark SL. New concepts of amniotic fluid embolism: a review. Obstet Gynecol Surv. 1990 Jun;45(6):360–8.
Hankins GD, Snyder RR, Clark SL, Schwartz L, Patterson WR, Butzin CA. Acute hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goat model. Am J Obstet Gynecol. 1993 Apr;168(4):1113-1129; discussion 1129-1130.
Gist RS, Stafford IP, Leibowitz AB, Beilin Y. Amniotic Fluid Embolism: Anesth Analg. 2009 May;108(5):1599–602.
Hacein-Bey L, Varelas PN, Ulmer JL, Mark LP, Raghavan K, Provenzale JM. Imaging of Cerebrovascular Disease in Pregnancy and the Puerperium. Am J Roentgenol. 2016 Jan;206(1):26–38.
Sultan P, Seligman K, Carvalho B. Amniotic fluid embolism: update and review. Curr Opin Anaesthesiol. 2016 Jun;29(3):288–96.
West M. Amniotic fluid embolism: a historical perspective in diagnosis and management. BJOG Int J Obstet Gynaecol. 2016 Jan;123(1):110.
Kobayashi H. Comparison of the Different Definition Criteria for the Diagnosis of Amniotic Fluid Embolism. J Clin Diagn Res [Internet]. 2017 [cited 2017 Oct 23]; Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&volume=11&issue=7&page=QC18&issn=0973-709x&id=10283.
Pacheco LD, Saade G, Hankins GDV, Clark SL. Amniotic fluid embolism: diagnosis and management. Am J Obstet Gynecol. 2016 Aug;215(2):B16–24.
Unal E, Balci S, Atceken Z, Akpinar E, Ariyurek OM. Nonthrombotic pulmonary artery embolism: imaging findings and review of the literature. Am J Roentgenol. 2017 Mar;208(3):505–16.
Plowman RS, Javidan-Nejad C, Raptis CA, Katz DS, Mellnick VM, Bhalla S, et al. Imaging of pregnancy-related vascular complications. RadioGraphics. 2017 Jul;37(4):1270–89.
Toledo P, Malinow AM. Embolic Disorders. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, et al., editors. Chestnut’s obstetric anesthesia: principles and practice. Philadelphia, PA: Elsevier/Saunders; 2014.
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