Amniotic Fluid Embolism

Amniotic fluid embolisation is a rare (2 per 100,000 deliveries) but severe condition where the amniotic fluid passes into the mother’s blood. This usually occurs around labour and delivery. The amniotic fluid contains fetal tissue, causing an immune reaction from the mother. This immune reaction to cells from the foetus leads to a systemic illness. It has more similarities to anaphylaxis than venous thromboembolism. The mortality rate is around 20% or above.

 

Risk Factors

The main risk factors for amniotic fluid embolus are:

  • Increasing maternal age
  • Induction of labour
  • Caesarean section
  • Multiple pregnancy

 

Presentation

Amniotic fluid embolisation usually presents around the time of labour and delivery, but can be postpartum. It can present similarly to sepsis, pulmonary embolism or anaphylaxis, with an acute onset of symptoms of:

  • Shortness of breath
  • Hypoxia
  • Hypotension
  • Coagulopathy
  • Haemorrhage
  • Tachycardia
  • Confusion
  • Seizures
  • Cardiac arrest

 

Management

The overall management of amniotic fluid embolism is supportive. There are no specific treatments.

Amniotic fluid embolism is a medical emergency – get help immediately. It requires the input of experienced obstetricians, medics, anaesthetics, intensive care teams and haematologists. They are likely to need transfer to the intensive care unit.

The initial management of any acutely unwell patient is with an ABCDE approach, assessing and treating:

  • A – Airway: Secure the airway
  • B – Breathing: Provide oxygen for hypoxia
  • C – Circulation: IV fluids to treat hypotension and blood transfusion in haemorrhage
  • D – Disability: Treat seizures and consider other neurological deficits
  • E – Exposure

 

Cardiopulmonary resuscitation and immediate caesarean section are required if cardiac arrest occurs.

 

Last updated September 2020
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