Emboli Air Ketuban - Ratih kumala fajar apsari; Bambang Suryono Suwondo (Jurnal Anestesi Obstetri Indonesia, 2018)
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