Amniotic fluid embolism (Complete) Flashcards
Define amniotic fluid embolism
Life-threatening condition that occurs when amniotic fluid, or other debris (e.g. foetal cells) enters the maternal circulation
Describe the aetiology of amniotic fluid embolism
Not completely known
Shortly after or during labour, amniotic fluid enters maternal circulation –> forms embolism –> blocks circulation
Fluid also triggers and inflammatory response resulting in immune response and DIC
Amniotic fluid embolism is most likely to occur during which phases of preganancy?
During or shortly after labour
What risk factors are associated with development of amniotic fluid embolism? (2)
Maternal age
Induction of labour
What are the main clinical features of amniotic fluid embolism?
Demographic:
Preganant women during or shortly post labour
Sudden onset
Symptoms:
Chills/shivering
Anxiety
Sweating
Coughing
Signs:
High respiratory rate
Tacchycardia
Hypotension
Hypoxia
DIC
What differentials should be considered alongside amnitoic fluid embolism?
PE
Septic shock
Anaphylactic shock
Hypovolaemic shock (due to placental abruption)
How does amniotic fluid embolism differ to PE?
DIC is a key feature of AFE versus to PE
AFE is pregnancy related
AFE is always sudden onset versus prolonged over hours like PE
How does AFE differ to septic shock?
More likely to be sudden onset and occurs exclusively during pregnancy
Septic shock associated with fever
How does AFE differ to anaphylactic shock?
Although both present with hypotension and SoB anaphylactic shock associated with rash and swelling
How does AFE differ to hypovolaemic shock (secondary to placental abruption)
Hypovolaemic shock due to placental abruption also presents with:
- Vaginal bleeding
- Uterine tenderness and contractions
- Progressive shock due to blood loss
What investigations should be considered in patients suspected of having AFE?
AFE is a clinical diagnosis however may consider investigations if uncertain to rule out differentials
Bedside:
Basic obs: Hypotension, hypoxia
ECG: Tacchycardia and to rule out PE
Bloods:
ABG: Check for respiratory failure
Blood cultures: Consider if patient febrile to rule out sepsis
FBC: low platelet count + rule out infection or haemorrhage
Coagulation panel: Signs of DIC which is hallmark of AFE
U&Es: Establish baseline
LFTs: Establish baseline
Imaging:
CXR: Check for alternative causes
CTPA: Rule out PE
ECHO: Rule out PE
What investigation is diagnostic for AFE?
No diagnostic investigation hence is a clinical diagnosis of exclusion
What findings are suggestive of DIC in AFE
Elevated D-dimer
Elevated aPTT/PTT
Low fibrinogen
How are patients with AFE managed?
Immediate transfer to ICU
Supportive:
Oxygen: maintain sats
Fluids resuscitation: Manage hypotension
Continous foetal monitoring: If occured before delivery
Medical:
Coagulopathy correction:
* Fresh frozen plasma (for prolonged pTT)
* Cyroprecipitate (for low fibrinogen)
* Platelet transfusion (for low platelets)
What can be given to correct prolonged pTT?
Fresh frozen plasma
What can be given to correct low fibrinogen?
Cyroprecipitate
What can be given to correct low platelets?
Platelet transfusion
