Recombinant activated factor VII in the treatment of severe bleeding during amniotic fluid embolism

Lucia Georgescu¹, Daniela Bălaşa², G. Tona³
1. Secţia A.T.I.; 2. Secţia Obstetrică; 3. Secţia Ginecologie, Spitalul Municipal Medgidia

Abstract

A female patient, aged 32 with caesarian section developed a severe bleeding 4 hours after surgery at the surgical wound, associated with a moderate respiratory deterioration. A new emergency surgical intervention was performed, concluded with a subtotal hysterectomy and right anexectomy. During surgery, the patient developed a severe disseminated intravascular coagulation and secondary fibrinolysis, which imposed massive transfusion and administration of aprotinine (Trasylol) and rFVIIa (NovoSeven®). Bleeding stopped only when 20 mg NovoSeven were injected. The extreme severity of DIC and secondary fibrinolysis, as well as the respiratory alteration, suggested a rare and serious complication of the caesarian section: the amniotic fluid embolism. The patient had a favorable evolution and after 84 hours of hospitalization in the ICU, she was transferred to the Department of Obstetrics. 7 days later she was discharged from the hospital.

Keywords: caesarian section, amniotic fluid embolism, bleeding, rFVIIa