Amniotic Fluid Embolism

Question 1

What is an AFE?

Answer 1

rare but severe complication during or after labour where amniotic fluid enters the maternal circulation, often leading to symptoms akin to a pulmonary embolism.

Question 2

What causes an AFE?

Answer 2

Known to trigger an inflammatory response in the mother’s immune system, leading to disseminated intravascular coagulation.

Question 3

What are key signs and symptoms of AFE?

Answer 3

Key signs and symptoms include
high respiratory rate
tachycardia
hypotension
hypoxia
disseminated intravascular coagulopathy.

Question 4

What are the main differentials for AFE?

Answer 4

Septic shock: Fever, increased heart rate, confusion

Anaphylactic shock: Rash, swelling, shortness of breath, low blood pressure

Pulmonary embolism: Chest pain, shortness of breath, irregular heartbeat

Hypovolaemic shock (e.g. due to placental abruption): Rapid heartbeat, cold and sweaty skin, irregular heart rhythm

Question 5

How is AFE diagnosed?

Answer 5

Purely clinical diagnosis based on signs and symptoms - no diagnostic test

Question 6

How is AFE managed?

Answer 6

Immediate transfer to an intensive care unit

Continuous foetal monitoring if the embolism has occurred before delivery

Provision of oxygen and fluid resuscitation

Correction of any coagulopathy, including administration of fresh frozen plasma for prolonged PT, cryoprecipitate for low fibrinogen, and platelet transfusion for low platelets