Amniotic fluid embolism Flashcards
Define amniotic fluid embolism.
This is an obstetric emergency.
Amniotic fluid and fetal cells enter maternal circulation causing cardiorespiratory failure. This is most likely to occur during pregnancy or in the immediate post-partum stage.
Explain the aetiology of amniotic fluid embolism.
Unclear mechanism of entry, causes anaphylactoid or complement reaction. Most likely to occur during delivery or in the immediate post-partum stage.
What are the risk factors for amniotic fluid embolism?
Multiparity, high maternal age, C-section, uterine hyperstimualtion/uterotonics, trauma, termination of pregnancy.
Summarise the epidemiology of amniotic fluid embolism.
2/100,000 (rare)
Recognise the presenting symptoms of amniotic fluid embolism.
Dyspnea, chest pain, may collapse (like PE)
Recognise the signs of amniotic fluid embolism on physical examination.
Tachypnoea, cyanotic, hypotensive, tachycardic, coagulopathy.
Identify appropriate investigations for amniotic fluid embolism and interpret the results.
- Blood: FBC, clotting, U&Es, Cross-match.
- Imaging: CXR
- Other: ECG
How does an amniotic fluid embolism cause LVF?
Amniotic fluid in lungs > Pulmonary artery (PA) spasm > High PA pressure > High RVP > Acute RHF and therefore hypoxia > Myocardial damage and LVF.
Generate a management plan for amniotic fluid embolism.
- Supportive: ITU.
- Airway (maintain), breathing (HFO2), circulation (2x large bore cannulae, fluid resusc, consider PA catheter and ionotropic support).
- If coagulopathic, consider FFP/Cry or transfusion.
- Consider delivery
Identify the possible complications of amniotic fluid embolism and its management.
Cardiac arrest, death, DIC, seizures, uterine atony and haemorrage, pulmonary odema/ARDS, renal failure.
Summarise the prognosis for patients with amniotic fluid embolism.
Mortality 30-40%. 25% of this in the first hour.
