Amniotic Fluid Embolism

Question 1

What is an amniotic fluid embolism?

Answer 1

Amniotic fluid embolisation is a rare (2 per 100,000 deliveries) but severe condition where the amniotic fluid passes into the mother’s blood. This usually occurs around labour and delivery. The amniotic fluid contains fetal tissue, causing an immune reaction from the mother. This immune reaction to cells from the foetus leads to a systemic illness. It has more similarities to anaphylaxis than venous thromboembolism. The mortality rate is around 20% or above.

Question 2

Risk factors for fluid embolus?

Answer 2

The main risk factors for amniotic fluid embolus are:

Increasing maternal age
Induction of labour
Caesarean section
Multiple pregnancy

Question 3

How do amniotic fluid embolisms present?

Answer 3

Amniotic fluid embolisation usually presents around the time of labour and delivery, but can be postpartum. It can present similarly to sepsis, pulmonary embolism or anaphylaxis, with an acute onset of symptoms of:

Shortness of breath
Hypoxia
Hypotension
Coagulopathy
Haemorrhage
Tachycardia
Confusion
Seizures
Cardiac arrest

Question 4

Management of amniotic fluid embolism?

Answer 4

The overall management of amniotic fluid embolism is supportive. There are no specific treatments.

Amniotic fluid embolism is a medical emergency – get help immediately. It requires the input of experienced obstetricians, medics, anaesthetics, intensive care teams and haematologists. They are likely to need transfer to the intensive care unit.

The initial management of any acutely unwell patient is with an ABCDE approach, assessing and treating:

A – Airway: Secure the airway
B – Breathing: Provide oxygen for hypoxia
C – Circulation: IV fluids to treat hypotension and blood transfusion in haemorrhage
D – Disability: Treat seizures and consider other neurological deficits
E – Exposure

Cardiopulmonary resuscitation and immediate caesarean section are required if cardiac arrest occurs.