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
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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
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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
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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
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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
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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
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