Amniotic fluid embolism

Question 1

Define amniotic fluid embolism.

Answer 1

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

Question 2

Explain the aetiology of amniotic fluid embolism.

Answer 2

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

Question 3

What are 6 risk factors for amniotic fluid embolism?

Answer 3

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

Question 4

Summarise the epidemiology of amniotic fluid embolism.

Answer 4

2/100,000 (rare)

Question 5

Recognise the presenting symptoms of amniotic fluid embolism.

Answer 5

Dyspnea
Chest pain
May collapse (like PE)

Question 6

Recognise 5 signs of amniotic fluid embolism on physical examination.

Answer 6

Tachypnoea
Cyanotic
Hypotensive
Tachycardic
Coagulopathy.

Question 7

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

Answer 7

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

Question 8

How does an amniotic fluid embolism cause LVF?

Answer 8

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

Question 9

Generate a management plan for amniotic fluid embolism.

Answer 9

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

Question 10

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

Answer 10

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

Question 11

Summarise the prognosis for patients with amniotic fluid embolism.

Answer 11

Mortality 30-40%.
25% in 1h