Amniotic Fluid Embolism

Question 1

What is an AFE?

Answer 1

amniotic fluid entering maternal circulation triggering a serious reaction (cardiorespiratory collapse and/or coagulopathy.)

Question 2

Why does it happen?

Answer 2

Thought to be due to humoral, haemodynamic and coagulopathic changes - Similar response to anaphylaxis and septic shock.

Question 3

Other names?

Answer 3

Anaphylactoid syndrome of pregnancy
Sudden obstetric collapse syndrome

Question 4

Risk factors?

Answer 4

IOL with prostaglandin
maternal age, Csection or instrumental, placenta praevia, Multiple pregnancy

Question 5

Diagnosis?

Answer 5

acute hypotension, Haemorrhage/Coagulopathy, Acute hypoxia, cardiac arrest/seizure

Question 6

Coagulopathy?

Answer 6

AFE is almost always associated with a form of disseminated intravascular coagulopathy (DIC).

Question 7

What is Disseminated Intravascular Coagulation (DIC)?

Answer 7

inappropriate coagulation within the blood vessels leading to failed clotting and haemorrhage

Question 8

When does it usually happen?

Answer 8

In labour or TOB

Question 9

What investigations can we do?

Answer 9

low hb, high wbc, X-ray, blood gases

Question 10

How do we manage it?

Answer 10

ABCD (D- delivery)

Question 11

What are the outcomes?

Answer 11

fatality 11-30%, 7% brain injury