Rapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism

Int J Obstet Anesth. 2007 Jul;16(3):269-73. doi: 10.1016/j.ijoa.2006.10.008. Epub 2007 Mar 6.


We describe a case of amniotic fluid embolism presenting as cardiovascular collapse during labour. After initial resuscitation and emergency caesarean section, the patient was transferred to the intensive care unit with profound hypoxaemia, a high inotropic drug requirement and severe coagulopathy. A transoesophageal echocardiogram demonstrated acute right ventricular overload, severe pulmonary artery hypertension and marked diastolic dysfunction of the left ventricle secondary to a dilated right ventricle. The introduction of nitric oxide at 40 ppm produced a dramatic improvement in her cardiorespiratory status. Mother and baby both survived with no apparent long term sequelae.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Analgesia, Epidural
  • Anesthesia, General
  • Apgar Score
  • Blood Coagulation Tests
  • Echocardiography, Transesophageal
  • Embolism, Amniotic Fluid / physiopathology*
  • Female
  • Humans
  • Hypertension, Pulmonary / drug therapy
  • Hypertension, Pulmonary / etiology
  • Infant, Newborn
  • Male
  • Nitric Oxide / therapeutic use*
  • Pregnancy
  • Shock / drug therapy*
  • Shock / etiology*


  • Nitric Oxide