1.1 Amniotic Fluid Embolism Flashcards
Signs a/w AFE
- Hypoxia + Cyanosis
- Bleeding d/t Coagulopathy
DIC 83% - CVs collapse
- Transient hypertension
- Cardiac Arrest
- Fetal distress
HR <110 >10m
<60 >3m - Pulmonary Oedema
- Seizures
Tonic-Clonic 50% - Uterine Atony
- Bronchospasm
Symptoms
- SOB - acute onset
- Cough
- Productive if APO - Chest pain
- Headache
Pathogenesis
D/T Passage fetal tissues
(squames / follicles)
Into maternal circulation
Requires:
Ruptured membranes
Open maternal veins
pressure gradient to drive squames across
Pathogenesis
Systemic reaction to fetal tissues
in Circulation appears key
Exact process remains elusive
Originally thought to be physical consequence
similar to PE
Proposed 2 phase immune response to fetal antigens
Phase 1 + 2
Phase 1 + 2
Phase 1: Response to fetal tissue antigens production vasoactive substances Pulmonary artery vasospasm = Acute RHF Hypoxaemia
Phase 2:
?Survives
Biochem reaction mediates:
- Increase capillary permeability
- DIC
- Uterine Atony
Management
Recognition of Diagnosis whilst managing consequences
Structures aggressive resus
required quickly reduce mortality
Call for help
anaesthetic +
Obstetric + Midwife for fetus
Airway
Consider ETT if profound hypoxia
Breathing High flow and CPAP Rx hypoxia Increase Intra alveolar pressure + reduce APO - Ultimately IPPV + PEEP?
MX
Circulation:
Fluids and vasopressors maintain systemic organ perfusion
Invasive monitors
Wide bore access
Left Lateral tilt:
Reduces aortocaval compression
Improves blood pressure and placental perfusion
Haemorrhage:
DIC activation TF and factor X
Send blood FBC/ Coag/ Fib
Major Haemorrhage protocol
Blood products as guided
(Factor VIIa used)
Consider TEG
Mx
Uterine atony Obs involvement Oxytocic agents Compression Massage: Help tone and reduce blood loss
Seizures
Termination w/ short acting anticonvulsants:
BZD
Fetus:
Delivery section
If circ arrest >5m
