Amniotic Fluid Embolism Flashcards
What is an amniotic fluid embolism?
amniotic fluid embolism is a rare but life-threatening obstetric emergency where amniotic fluid enters the maternal circulation, triggering a severe inflammatory and haemostatic response.
What causes amniotic fluid to enter the maternal circulation?
It occurs when there is a breach in the uteroplacental barrier, such as during labour, delivery, or trauma.
When does amniotic fluid embolism typically occur?
amniotic fluid embolism typically occurs during labour, caesarean delivery, or within 30 minutes postpartum.
What are the two phases of amniotic fluid embolism?
Phase 1: Pulmonary vasospasm and right ventricular failure. Phase 2: Haemorrhagic phase with disseminated intravascular coagulation (DIC).
What are the risk factors for amniotic fluid embolism?
Risk factors include advanced maternal age, multiple pregnancies, placental abruption, placenta praevia, caesarean delivery, and instrumental delivery.
What are the classic symptoms of amniotic fluid embolism?
Symptoms include sudden onset of dyspnoea, hypotension, cyanosis, tachycardia, chest pain, and altered mental status.
What are the clinical signs of amniotic fluid embolism?
Signs include hypoxaemia, hypotension, cardiac arrest, and coagulopathy, often accompanied by massive haemorrhage.
How does amniotic fluid embolism affect the cardiovascular system?
amniotic fluid embolism causes acute pulmonary hypertension, right ventricular failure, and hypotension due to reduced cardiac output.
How does amniotic fluid embolism affect the respiratory system?
amniotic fluid embolism leads to acute respiratory distress syndrome (ARDS), hypoxia, and cyanosis due to pulmonary vasospasm and capillary leak.
How does amniotic fluid embolism affect the coagulation system?
amniotic fluid embolism triggers disseminated intravascular coagulation (DIC), resulting in widespread clotting, consumption of clotting factors, and haemorrhage.
How is amniotic fluid embolism diagnosed?
Diagnosis is clinical, based on sudden cardiovascular collapse, hypoxaemia, and coagulopathy during labour or shortly postpartum.
What investigations can support a diagnosis of amniotic fluid embolism?
Supportive investigations include arterial blood gases (showing hypoxaemia), coagulation studies (showing DIC), and chest X-ray (showing pulmonary oedema).
What is the primary treatment for amniotic fluid embolism?
Treatment is supportive, focusing on resuscitation, oxygenation, haemodynamic stabilisation, and managing coagulopathy.
What immediate steps are taken in suspected amniotic fluid embolism?
Immediate steps include calling for help, initiating cardiopulmonary resuscitation (CPR) if needed, and providing high-flow oxygen.
What fluids and medications are used to stabilise amniotic fluid embolism?
Intravenous fluids, vasopressors (e.g., norepinephrine), and inotropes (e.g., dobutamine) are used to support blood pressure and cardiac output.
How is coagulopathy managed in amniotic fluid embolism?
Coagulopathy is managed with fresh frozen plasma (FFP), cryoprecipitate, platelets, and fibrinogen replacement.
What is the prognosis for amniotic fluid embolism?
Prognosis is poor, with high maternal mortality (up to 50%) and significant neonatal morbidity and mortality if untreated.
What are the long-term complications of amniotic fluid embolism?
Long-term complications include neurological deficits, organ failure, and psychological impacts like post-traumatic stress disorder (PTSD).
What are the differential diagnoses for amniotic fluid embolism?
Differential diagnoses include pulmonary embolism, myocardial infarction, eclampsia, anaphylaxis, and sepsis.
How does amniotic fluid embolism affect fetal outcomes?
amniotic fluid embolism increases the risk of fetal hypoxia, preterm delivery, and stillbirth due to maternal cardiovascular collapse.
What is the role of ECMO in managing amniotic fluid embolism?
Extracorporeal membrane oxygenation (ECMO) may be considered in refractory cases to support oxygenation and circulation.
What is the role of perimortem caesarean section in amniotic fluid embolism?
Perimortem caesarean delivery is performed within 4-5 minutes of maternal cardiac arrest to improve maternal and neonatal outcomes.
What preventative measures are available for amniotic fluid embolism?
There are no specific preventive measures, but early recognition and prompt management of obstetric complications can reduce risk.
What is the importance of multidisciplinary care in amniotic fluid embolism?
Multidisciplinary care involving obstetricians, anaesthetists, intensivists, and haematologists is essential for effective management of amniotic fluid embolism.
