Amniotic Fluid Embolism

!!! OBSTETRIC EMERGENCY !!!

When amniotic fluid (containing fetal cells) enters the mothers bloodstream, resulting in a severe reaction primarily affecting the heard and lungs.  

• Rare complication of pregnancy associated with a high mortality rate (20%)

• Neither predictable or preventable 

• No clear cause has been found

Risk Factors

• Most significantly associated with increased maternal age and induction of labour. 

• Multiple pregnancy

• Uterine rupture

• Placenta praevia

• Placental abruption

• Cervical laceration

• Eclampsia

• Polyhydramnios

• Caesarean or instrumental delivery

Presentation

• Acute, rapid onset

• The majority of cases occur in labour, though they can also occur during caesarean section and immediately postpartum.

• Hypoxia/respiratory failure

• Hypotension 

• Tachycardia 

• Fetal distress

• Shock 

• Confusion

• Myocardial infarction/ cardiac arrest 

• Disseminated Intravascular Coagulation (DIC)- nearly all patients will develop this ithin 4 hours 

Differentials 

• PE

• Anaphylaxis

• Sepsis

• MI

• Eclampsia

Diagnosis

• Cannot be tested for - diagnosis of exclusion

• Presence of sudden breathlessness, hypotension and widespread uncontrolled bleeding (DIC) prompts diagnosis 

• Can only diagnose officially in post mortem - debris and fetal squamous cells found in pulmonary vasculature 

Management

• Diagnosis not required for management as is predominantly supportive (ABCDE)

• Involvement of multidisciplinary team (eg. anaesthetists, haematologists)

• The baby may be delivered immediately via forceps, vacuum extractor or cesarean. This does not improve the status of the mother however it may save the baby.