Amniotic Fluid Embolism

Question 1

What is an amniotic fluid embolism?

Answer 1

Obstetric emergency. Amniotic fluid and fetal cells enter maternal circulation causing cardiorespiratory failure.

Question 2

What is the aetiology of amniotic fluid embolism?

Answer 2

Unclear mechanism of entry, causes anaphylactoid or complement reaction

Question 3

What are the RFs of amniotic fluid embolism?

Answer 3

Multiparity
Age (Higher)
C section
Uterine hyperstimulation/uterotonics
Trauma
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Question 4

What is the epidemiology of amniotic fluid embolism?

Answer 4

2/100k.

Question 5

What might you find in a history or exam of amniotic fluid embolism?

Answer 5

SOB/dyspnea, chest pain, may collapse (like PE)

Tachypnoea, cyanotic, hypotense, tachycardic, coagulopathy.

Question 6

What is the pathology of amniotic fluid embolism?

Answer 6

Amniotic fluid in lungs -> pulmonary artery spasm -> high PA pressure -> High RVP -> Acute RHF and therefore hypoxia -> myocardial damage and LVF.

Question 7

What investigations would you do in amniotic fluid embolism?

Answer 7

Blood: FBC, clotting, UE, X match.

Imaging: CXR

Other: ECG

Question 8

What is the management of amniotic fluid embolism?

Answer 8

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.

Question 9

What are the complications/ prognosis of amniotic fluid embolism?

Answer 9

Cardiac arrest, death, DIC , seizures, uterine atony and haemorrage, pulmonary odema/ARDS, renal failure.

Mortality 30-40%. 25% of this in the first hour.