Amniotic fluid embolism Flashcards
Define amniotic fluid embolism.
Obstetric emergency.
Amniotic fluid + fetal cells enter maternal circulation causing cardiorespiratory failure.
Explain the aetiology of amniotic fluid embolism.
Unclear mechanism of entry, causes anaphylactoid or complement reaction.
Most likely to occur during delivery or in immediate post-partum stage.
What are 6 risk factors for amniotic fluid embolism?
Multiparity
High maternal age
C-section
Uterine hyperstimualtion/ uterotonics
Trauma
TOP
Summarise the epidemiology of amniotic fluid embolism.
2/100,000 (rare)
Recognise the presenting symptoms of amniotic fluid embolism.
Dyspnea
Chest pain
May collapse (like PE)
Recognise 5 signs of amniotic fluid embolism on physical examination.
Tachypnoea
Cyanotic
Hypotensive
Tachycardic
Coagulopathy.
Identify appropriate investigations for amniotic fluid embolism and interpret the results.
FBC, clotting, U+Es, X-match.
CXR
ECG
How does an amniotic fluid embolism cause LVF?
Amniotic fluid in lungs > Pulmonary artery (PA) spasm > High PA pressure > High RVP > Acute RHF + therefore hypoxia > Myocardial damage + LVF.
Generate a management plan for amniotic fluid embolism.
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
Identify 7 possible complications of amniotic fluid embolism and its management.
Cardiac arrest
Death
DIC
Seizures
Uterine atony + haemorrage
Pulmonary odema/ ARDS
Renal failure.
Summarise the prognosis for patients with amniotic fluid embolism.
Mortality 30-40%.
25% in 1h