This rare complication has been recorded seventeen times prior to 1950. Though rare, it comprises 10% of all maternal deaths. Epidemiology Īmniotic fluid embolism is very uncommon and the rate at which it occurs is 1 instance per 20,000 births. However, since the circumstances that lead to this complication are difficult to influence, treatment to resolve the symptoms and deteriorating vascular conditions can improve outcomes. Treatment Ī case report on Amniotic Fluid Embolism published in the A & A Practice Journal in 2020 has revealed that when milrinone is administered as an aerosol, selective pulmonary vasodilation occurs without significant changes in mean arterial pressure or systemic vascular resistance and if used immediately after Amniotic Fluid Embolism, inhaled milrinone may mitigate the pulmonary vasoconstriction. Diagnosis is also based upon the signs and symptoms observed during the birth or procedures. The presence of fetal squamous cells or other fetal tissues, including meconium, have been found in the maternal circulation after the event. Diagnosis ĪFE is diagnosed when all other causes have been excluded. A maternal age of 35 years or older is associated with AFE. However, other studies have refuted this claim. Īccording to one study, induction of labor may double the risk of AFE. Small lacerations in the lower reproductive tract are associated with AFE. The condition can also develop after elective abortion, amniocentesis, cesarean delivery, or trauma. Disseminated intravascular coagulation occurs and results in serious bleeding. When the fetal cells and amniotic fluid enter the bloodstream, reactions occur that cause severe changes in the mechanisms that affect blood clotting. Upon later analysis, fetal cells are found in the maternal circulation. The disorder occurs during the last stages of labor when amniotic fluid enters the circulatory system of the mother via tears in the placental membrane or uterine vein rupture. There is much variation in how each instance progresses. Though symptoms and signs can be profound, they also can be entirely absent. Signs and symptoms Īmniotic fluid embolism is suspected when a woman giving birth experiences very sudden insufficient oxygen to body tissues, low blood pressure, and profuse bleeding due to defects in blood coagulation. This condition is unpredictable and no risk factors have been verified. The rate at which it occurs is 1 instance per 20,000 births and it comprises 10% of all maternal deaths. Pathophysiology of the amniotic fluid embolismĪn amniotic fluid embolism (AFE) is a very uncommon childbirth ( obstetric) emergency in which amniotic fluid enters the blood stream of the mother, triggering a serious reaction, which results in cardiorespiratory (heart and lung) collapse and massive bleeding ( coagulopathy). Intravascular squames are present in this example of amniotic fluid embolism. ©2018 American Association of Critical-Care Nurses.Medical condition Amniotic fluid embolism Staff debriefing and psychological support for the woman and family are vital.Īmniotic fluid embolism critical care disseminated intravascular coagulation heart failure posttraumatic stress. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Diagnosis is by exclusion and clinical presentation. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation.

The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. Obstetric emergencies often require intensive care intervention.

Amniotic fluid embolism pdf