Amniotic fluid embolism Flashcards

1
Q

Define amniotic fluid embolism.

A

Obstetric emergency.
Amniotic fluid + fetal cells enter maternal circulation causing cardiorespiratory failure.

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2
Q

Explain the aetiology of amniotic fluid embolism.

A

Unclear mechanism of entry, causes anaphylactoid or complement reaction.
Most likely to occur during delivery or in immediate post-partum stage.

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3
Q

What are 6 risk factors for amniotic fluid embolism?

A

Multiparity
High maternal age
C-section
Uterine hyperstimualtion/ uterotonics
Trauma
TOP

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4
Q

Summarise the epidemiology of amniotic fluid embolism.

A

2/100,000 (rare)

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5
Q

Recognise the presenting symptoms of amniotic fluid embolism.

A

Dyspnea
Chest pain
May collapse (like PE)

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6
Q

Recognise 5 signs of amniotic fluid embolism on physical examination.

A

Tachypnoea
Cyanotic
Hypotensive
Tachycardic
Coagulopathy.

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7
Q

Identify appropriate investigations for amniotic fluid embolism and interpret the results.

A

FBC, clotting, U+Es, X-match.
CXR
ECG

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8
Q

How does an amniotic fluid embolism cause LVF?

A

Amniotic fluid in lungs > Pulmonary artery (PA) spasm > High PA pressure > High RVP > Acute RHF + therefore hypoxia > Myocardial damage + LVF.

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9
Q

Generate a management plan for amniotic fluid embolism.

A

ITU.
A: maintain
B: HFO2
C: 2x large bore cannulae, fluid resus, consider PA catheter + ionotropic support

If coagulopathic, consider FFP/Cry or transfusion.

Consider delivery

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10
Q

Identify 7 possible complications of amniotic fluid embolism and its management.

A

Cardiac arrest
Death
DIC
Seizures
Uterine atony + haemorrage
Pulmonary odema/ ARDS
Renal failure.

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11
Q

Summarise the prognosis for patients with amniotic fluid embolism.

A

Mortality 30-40%.
25% in 1h

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