Amniotic Fluid Embolism

Abstract

Amniotic fluid embolism (AFE) is a rare but serious and potentially deadly complication of pregnancy that is unpreventable and unpredictable. Most AFE events occur during labor; however, approximately one third happen during the immediate postpartum period. Presentation is abrupt and thought to be an abnormal response to fetal materials entering maternal circulation through the placental insertion site. Care providers must recognize the signs and symptoms of AFE and react quickly to treat potential complications. This can be challenging as there are no set diagnostic criteria or specific laboratory tests. Generally, the diagnosis is based on clinical status when the classic triad of hypoxia, hypotension, and subsequent coagulopathy are noted in a laboring woman or woman who just gave birth, and no other plausible explanation can be determined. Proper treatment of AFE requires a multidisciplinary approach to decrease maternal morbidity and mortality. Knowledge, simulation, and familiarization of a Massive Obstetric Transfusion protocol can help all members of the perinatal team recognize and respond to women with AFE in a timely and effective manner. A case study is presented of a woman with a seemingly normal obstetric course that became complicated rapidly following development of an AFE.

Fitting a Square Peg in a Round Hole: A Simple Case of Chest Pain

“…Most of these occur during labor; but about one third happen during the immediate postpartum period. 3 This patient has no hypoxia, hypotension, or coagulopathy and is outside the expected time frame for amniotic fluid embolism, meaning we can likely remove it from the differential.…”

Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen

“…Some authors have suggested the ventricular dysfunction is secondary to either pulmonary hypertension caused by serotonin and thromboxane or systemic hypotension caused by vagal stimulation [ 1 , 11 ]. It has been proposed that Atropine and Ondansetron may act to block serotonin and vagal stimulation improving cardiovascular function rather than simply providing cardiovascular support [ 11 ].…”

“…Amniotic fluid embolism (AFE) is a rare, unpredictable, and potentially devastating complication of childbirth, in which amniotic fluid, fetal cells, hair, or other types of debris enter into the maternal pulmonary circulation, causing cardiovascular collapse [ 1 , 2 ]. The incidence of AFE ranges from 1 : 15,200 to 1 : 53,800 [ 3 – 5 ].…”

“…Early recognition and initiation of treatment of AFE are essential to increase the likelihood of patient survival [ 1 , 7 ]. This can be a challenge, as AFE is a diagnosis of exclusion with no universal pathological or serological markers [ 1 , 8 , 9 ].…”

“…Early recognition and initiation of treatment of AFE are essential to increase the likelihood of patient survival [ 1 , 7 ]. This can be a challenge, as AFE is a diagnosis of exclusion with no universal pathological or serological markers [ 1 , 8 , 9 ]. Transesophageal echocardiography (TEE) can be used to determine cardiac dysfunction due to pulmonary hypertension but may not be widely available on obstetric units [ 7 , 10 ].…”