Amniotic Fluid embolism

Question 1

What is amniotic fluid embolism?

Answer 1

The amniotic fluid enters maternal circulation and stimulates a severe systemic immune reaction as it contains fetal tissue

-> Anaphylactic syndrome of pregnancy

Life threatening

Question 2

When does amniotic fluid embolism occur?

Answer 2

Around time of delivery

Question 3

Risk factors for amniotic fluid embolism? (4)

Answer 3

Increasing maternal age
Induction of labour
Caesarean section
Multiple pregnancy

Question 4

Incidence of amniotic fluid embolism?

Answer 4

Very rare:
2:100,000

However it is the 5th leading cause of maternal death!

Question 5

What mechanisms of amniotic fluid embolism can lead to maternal death?

Answer 5

Embolism provokes an anaphylactic reaction or complement cascade ->
pulmonary artery spasm ->
increase pulmonary artery pressure and RVP ->
hypoxia myocardial and pulmonary capillary damage ->

LVF and death

Question 6

Clinical features of amniotic fluid embolism?

Answer 6

Bleeding = PPH due to resultant DIC (disseminated intravascular coagulation)

• SOB
• Cest pain
• Cyanosis
• Hypoxia, hypotension, tachypnoea

= occurs during or shortly after labour

Question 7

ABG of a women with amniotic fluid embolism?

Answer 7

hypoxaemia
raised PaCO2

Question 8

How to manage amniotic fluid embolism?

Answer 8

ABCDE
Call ITU reg:
- High flow oxygen , 2 large bore cannulae

Ionotropes

Consider delivery +/- hysterectomy

Question 9

What are the complications of amniotic fluid embolism?

Answer 9

Cardiac arrest
Death
DIC
Seizures
Uterine atony
Haemorrhage