Amniotic Fluid Embolism Flashcards
Define amniotic fluid embolism.
This is when fetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction.
How common is AFE?
Rare complication of pregnancy (incidence 2/ 100,000 in the UK)
But associated with a high mortality rate
What is the aetiology of AFE?
No clear cause has been proven - maternal circulation must be exposed to fetal cells/ amniotic fluid in order for an amniotic fluid embolism to occur but underlying pathology of this process which leads to the embolism is not well understood. May be immune mediated.
Exposure of maternal circulation to amniotic fluid causes acute cardiorespiratory compromise and severe DIC
What are the risk factors for AFE?
- 35% for induction of labour
- 13% BAME and _>_35yrs
- 7% for multiple pregnancy
When does AFE usually present?
The majority of cases occur in labour ,
But they can also occur during caesarean section and after delivery in the immediate postpartum.
What are the signs and symptoms of AFE?
Symptoms include:
- chills,
- shivering,
- sweating,
- anxiety
- coughing/SOB
- paraesthesia in fingers
Signs include:
- cyanosis,
- hypotension,
- bronchospasms,
- tachycardia.
- arrhythmia
- myocardial infarction.
How do you diagnose AFE?
Clinical diagnosis of exclusion, as there are not definitive diagnostic tests.
Usually diagnosed post-mortem with the presence of fetal cells (squames or hair) in the maternal pulmonary capillaries
What is the management of AFE?
Critical care unit by a MDT, management is predominantly supportive. ABC approach.
Perimortem caesarean section should be carried out within 5 minutes or ASAP after cardiac arrest. This is for the benefit of the woman to improve the effect of resuscitation
What is the prognosis of AFE?
Approx 30% die in the first hour
Only 10% survive overall
