Amniotic Fluid Embolism Flashcards
What is an amniotic fluid embolism?
Passage of amniotic fluid into the maternal circulation typically resulting in sudden, profound, and unexpected shock with cardiopulmonary collapse.
What are the clinical features of an amniotic fluid embolism?
- HoTN, cardiopulmonary arrest
- fetal distress
- pulmonary edema/ARDS
- cyanosis/dyspnea
- coagulopathy
- seizures
What obstetric/procedure related causes should be part of the differential diagnosis when suspecting amniotic fluid embolism?
acute hemorrhage placental abruption uterine atony peripartum cardiomyopathy eclampsia venous air embolism transfusion reaction
What anesthetic causes should be considered as part of the differential when suspecting amniotic fluid embolism?
high/total spinal
aspiration
local anesthetic systemic toxicity
What is the differential diagnosis when suspecting amniotic fluid embolism?
- obstetric causes (hemorrhage, abruption, atony, cardiomyopathy, eclampsia)
- anesthetic causes (high/total spinal, aspiration, local anesthetic toxicity)
- pulmonary thromboembolism
- VAE
- anaphylaxis
- sepsis
- intracranial hemorrhage
- transfusion reaction
What is the management of an amniotic fluid embolus?
- call for help and inform obstetrician because prompt delivery of the fetus improves maternal resuscitation outcomes
- intubate, 100% FiO2
- if pulseless, commence chest compressions and ACLS, maintain left uterine displacement
- large bore IV access
- expand circulating volume
- vasopressors, possible inotropes
- a-line
- obtain CVL
- stat bloods (ABG, CBC, coags, serum tryptase
- treat coagulopathy
- invasive monitors, TEE, follow UOP
How should you approach the coagulopathy associated with amniotic fluid embolism?
Maintain oxygen-carrying capacity with pRBCs
Use FFP and platelets, cryo is 2nd line but useful for low fibrinogen, or if concerned about ARDS/volume overload
- consider factor VIIa for refractory bleeding (recognize the risk of intravascular thrombosis with its use)
