Amniotic Fluid Flashcards
1
Q
What is an Amniotic Fluid Embolism?
A
Obstetric emergency in which amniotic fluid and foetal cells enter the maternal circulation leading to cardiorespiratory collapse
2
Q
How does an amniotic fluid emboli causes cardiorespiratory collapse?
A
- Embolism provokes an anaphylactic reaction or complement cascade
- Pulmonary artery spasm increases pulmonary artery pressure and RVP
- Hypoxic myocardial and pulmonary capillary damage
- LVF and death
Post-mortem reveals foetal squames and debris in the maternal pulmonary circulation
3
Q
What are the risk factors of amniotic fluid emboli?
A
- Increasing maternal age
- Induction of labour (use of uterotonics)
- Placenta praevia/abruption
- C-section
Often occurs without any risk factors
4
Q
What are the signs and symptoms of amniotic fluid embolism?
A
- Sudden onset SoB ± cyanosis
- Bleeding (activation of coagulation cascade) / DIC
- Seizures
- Hypotension
- O/E – tachypnoea; tachycardia, pulmonary oedema, uterine atony (uterus failing to contract)
5
Q
What are the appropriate investigations for suspected amniotic fluid emboli?
A
- ABG – hypoxaemia, raised PaCO2
- FBC– low Hb
- Clotting – low platelets, increased PT/APTT, decreased fibrinogen, UE, X-match
- CXR – cardiomegaly, pulmonary oedema
- ECG – right heart strain, rhythm abnormalities
6
Q
What is the management of amniotic fluid emboli?
A
- Immediate ABC + ITU referral
- High flow O2
- 2 large bore cannulae
- Fluid resus
- Pharmacological
- Ionotropics
- Correct coagulopathy
- FFP
- Cryoprecipitate
- Platelets
- Transfuse if needed
- Uterine atony - PPH management
- Consider delivery ± hysterectomy
7
Q
What are the complications of amniotic fluid emboli?
A
- Cardiac arrest
- Death
- DIC
- Seizures
- Uterine atony
- Haemorrhage
- Pulmonary oedema
- ARDS
- Renal failure
- Prognosis = Poor
- 75% survive - many mothers and children have sequelae
- 25% die within 12 hours
