AFE

Question 1

what is maternal mortality with AFE?

neonatal mortality?

Answer 1

80%; contributes to 10-15% of maternal deaths in developed world

neonatal mortality 10-15%

Question 2

pathogenesis?

Answer 2

amniotic fluid/proteins, or fetal cells enter maternal circulation and cause an anaphlyactic reaction

Question 3

what are clinical stages?

Answer 3

stage I: pulmonary and systemic vasoconstriction, causing hypoxemia (and R-heart strain/failure)
stage II: hypotension, decreased LV stroke work
stage III: coagulopathy, lung injury

myocardial infarction, neurologic, renal injury can occur

Question 4

criteria for diagnosis

Answer 4

• acute maternal hypotension or cardiac arrest
• acute maternal hypoxia
• coagulopathy or severe hemorrhage
• can occur during labor, delivery, after D&E, even up to 48 hrs after

diagnosis of exclusion; often may not have all of these

Question 5

management

Answer 5

get appropriate teams: anesthesia, critical care, MFM, neonatology

oxygenation and circulation

• high flow oxygen and/or intubation
• delivery if not already delivered. or if cardiac arrest, consider peri-mortem c-section
• judicious use of fluids
• consider A-line to measure blood pressure and central venous pressure catheter

control coagulopathy and hemorrhage

• massive transfusion
• OR
• call VIR
• if needed hyst

clincial diagnosis, but CBC, coags, ABG, BMP would be helpful