Amniotic Fluid Embolism Flashcards
1
Q
What is an amniotic fluid embolism?
A
- an acute cardio-respiratory collapse within 6 hours after labour, birth or ruptured membranes with no other identifiable cause, followed by acute coagulopathy in those women who survive the initial event
- clinical diagnosis —> acute hypotension, cardiac arrest, acute hypoxia, coagulopathy
- pathological diagnosis —> presence of fetal squames or hair in the lungs
2
Q
What is the incidence of AFE?
A
- incidence estimated to be 1.7:100000
- high mortality rate of around 11-61%
- perinatal mortality and morbidity rates also high
3
Q
What is the pathophysiology of AFE?
A
- can cause an inflammatory response similar to anaphylaxis, haemodynamic, humeral and coagulation changes lead to the signs and symptoms of AFE
- tears in the fetal membranes and the uterine vessels which allow amniotic fluid to enter the uterine vein and into the maternal pulmonary arterial circulation
- initially leads to blockage to the pulmonary arterioles and alveolar capillaries causing pulmonary vasospasm, hypoxia, oedema, circulatory compromise
4
Q
What are some of the signs and symptoms?
A
- hypotension
- fetal distress
- pulmonary oedema
- cardiopulmonary arrest
- cyanosis
- coagulopathy
- respiratory distress
- convulsions
- uterine atony
- bronchospasm
- chest pain
- altered mental state
- fetal compromise
5
Q
What are some of the pre-disposing factors?
A
- situations where intra-amniotic pressure is increased and membranes rupture
- multiple pregnancy
- polyhydramnios
- abruption/placenta praevia
- multiparity
- induction/augmentation
- meconium
- maternal age >35 years
- eclampsia
- uterine hyperstimulation
- hypertonic contractions
- rapid or precipitate birth
- invasive interventions in labour
6
Q
How should AFE be managed?
A
- call for help
- IV access and IV fluids
- ventilation (oxygen administration, intubation)
- chest compressions if necessary (CPR)
- deliver the baby if necessary
- insert catheter
- consider blood transfusion
- maintain uterine tone
- maternal observations
- bloods FBC, group and X match, coagulation