University of Iowa Hospitals & Clinics recently managed not one but two cases of extremely rare Amniotic Fluid Embolism (AFE) in the hospital’s Labor & Delivery unit.
In AFE, amniotic fluid enters the mother’s bloodstream, triggering a serious reaction that can include heart and lung collapse and severe hemorrhage. Statistics regarding the incidence of AFE vary, but estimates generally are 1 in 40,000 deliveries in North America. To have two cases in the same hospital within a week is extraordinarily rare.
Mortality rates associated with AFE are very high, with some sources citing a 90 percent death rate.
In both of the recent UIHC cases, mother and baby not only survived, but left the hospital healthy despite cardiac arrest and massive hemorrhage.
The cases and their outcomes were so remarkable that the Department of Obstetrics hosted a “Medical Miracles” celebration that included a review of both cases and recognition of the “excellent teamwork” of the providers involved, which included OB faculty and residents; Anesthesia faculty and residents; Nursing; and NICU teams.
“The fact that both mom and baby survived required excellent clinical skills, critical thinking, and teamwork from everyone involved,” says Teresa Horak, MS RN, RNC-OB, C-EFM, associate director of nursing for Women’s Health Services/Department of Nursing/Department of Obstetrics and Gynecology.
“This was outstanding clinical care from everyone involved, and all the more remarkable because most providers only learn about AFE from textbooks and the literature. Very few of us have seen a case ourselves,” says Kirke Rogers, MD, who leads the Department of Anesthesia’s Learning from Excellence initiative.
The providers involved in the two cases were:
- Drs. Emily Jacobs, Rachel Maassen, Jordan Mattson, Stephanie Radke, and Avery Whitis from Obstetrics and Gynecology
- Drs. Jen Berger, Trassanee Chatmethakul, Heidi Harmon, Steve McElroy, David Segar, and Alex Tuttle from Pediatrics/Neonatology
- Drs. Mina Alfi, Yasser El-Hattab, Gareth Gardiner, Jordan Hill, Sundar Krishnan, Timothy Mundell, Justin Norvell, Emma Swanson, Coby Thompson, Sapna Ravindranath, and Cynthia Wong from Anesthesia
- Nursing Manager Amy Sanborn
- Assistant Nurse Manager Heidi Bernard
- ARNPs Lindsey Behrens and Rachel Dougherty
- Nurses Emily Baatz, Claudia Bedell, Mary Beougher, Samantha Boyd, Mary Burton, Courtney Buhmeyer, Tara Carter, Gina Cetta, Sherry Evans, Natalie Feuerbach, Pamela Karkosh, Ashley Kempf, Sara Miller, Stacey Neeld, Alisha Neilson, Ashley Patterson, Rania Schreiber, Kelsey Stueland, Mary Munro, Audrey Watkins, Christine Weber, and Brenda Wolf.