Amniotic Fluid Embolism

Aka: Amniotic Fluid Embolism, Pulmonary Embolism of Amniotic Fluid, Anaphylactoid Syndrome of Pregnancy

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II. Epidemiology

  1. Incidence: 1 in 8000 to 80,000 live births

III. Pathophysiology

  1. Amniotic fluid released into maternal circulation
  2. Amniotic fluid induces anaphylactoid-type immunologic response
  3. Results in transient pulmonary artery spasm
  4. Causes Hypoxia, pulmonary capillary injury and left ventricular injury
  5. Results in Left Ventricular Failure, ARDS, DIC and multi-system failure

IV. Symptoms

  1. Severe, sudden onset Dyspnea

V. Signs

  1. Tachypnea
  2. Hypoxia
  3. Severe shock of rapid onset
  4. Altered Mental Status or encephalopathy
  5. Cyanosis
  6. Hypotension
  7. Cardiopulmonary arrest

VI. Risk Factors

  1. Trauma in Pregnancy
  2. Amniotomy
  3. Strong uterine contractions

VII. Differential Diagnosis

  1. Pregnancy Induced Hypertension
  2. Abruptio Placentae
  3. Uterine Rupture
  4. Aspiration Pneumonia

VIII. Lab

  1. Arterial Blood Gas
  2. Complete Blood Count with Platelets
    1. Thrombocytopenia
  3. Urinalysis
  4. Type and Cross 4-6 units Packed Red Blood Cells
  5. Coagulation studies
    1. D-Dimer
    2. ProTime (PT, INR)
    3. Partial Thromboplastin Time (PTT)
    4. Fibrin split products (Fibrin Degradation Products)
    5. Fibrinogen (low)
    6. Clot Test

IX. Imaging

  1. Chest XRay
    1. Bilateral infiltrates may be seen with progression

X. Diagnostics

  1. Electrocardiogram (EKG)
    1. Sinus Tachycardia
    2. Dysrhythmias

XI. Management

  1. Emergent supportive care
    1. Oxygen Supplementation
    2. Intravenous Access
    3. Endotracheal Intubation
    4. Vasopressors
    5. Fluid Resuscitation
    6. Correct coagulation deficits
  2. Advanced Measures to consider
    1. Venoarterial ECMO
    2. Uterine Artery Embolization
    3. Exchange Transfusion
  3. A-OK Amniotic Fluid Embolism Protocol
    1. Atropine 1 mg IV (vagolytic) AND
    2. Ondansetron 8 mg IV (Serotonin blockade) AND
    3. Ketorolac 30 mg IV (Thromboxane production blockade)
    4. Rezai (2017) Case Rep Obstet Gynecol +PMID: 29430313 [PubMed]
      1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753013/
  4. Admit to Intensive Care unit
  5. Consultations
    1. Maternal-fetal medicine
    2. Medicine
    3. Neonatology

XII. Monitoring

  1. Check Hemoglobin every 1 hour (keep above 10 mg/dl)
  2. Check Hematocrit every 1 hour (keep above 30)
  3. Check coagulation studies every 2 hours
  4. Fetal scalp electrode
  5. Tocometry or intrauterine pressure catheter
  6. Monitor strict intake and output
    1. Keep Urine Output > 30 cc per hour

XIII. Prognosis

  1. Mortality approaches 61% for mothers
    1. Low survival rate for fetus if still in utero
    2. Surviving mothers have intact neurologic function in only 15% of cases

XIV. References

  1. Krywko and Jennings (2018) Crit Dec Emerg Med 32(4): 3-11
  2. Lively and Clare (2022) Crit Dec Emerg Med 36(5): 4-10
  3. Clark (1995) Am J Obstet Gynecol 172(4): 1158-69 [PubMed]

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Related Studies

Ontology: Embolism, Amniotic Fluid (C0013927)

Definition (NCI) Acute hypotension or cardiac arrest, acute hypoxia or coagulopathy in the absence of any other potential explanation related to the presence of amniotic fluid or the fetal debris within the maternal vascular system during the antepartum or intrapartum period.(NICHD)
Definition (MSH) Blocking of maternal circulation by AMNIOTIC FLUID that is forced into uterine VEINS by strong UTERINE CONTRACTION near the end of pregnancy. It is characterized by the sudden onset of severe respiratory distress and HYPOTENSION that can lead to maternal DEATH.
Concepts Disease or Syndrome (T047)
MSH D004619
ICD9 673.10, 673.1
ICD10 O88.1
SnomedCT 17263003
English Amniotic Fluid Embolisms, Embolism, Amniotic Fluid, Embolisms, Amniotic Fluid, EMBOLUS AMNIOTIC FLUID, Embolus amniotic fluid, Amniotic fluid embolus, Amniotic fluid embolism, unspecified as to episode of care, amniotic fluid embolism (diagnosis), amniotic fluid embolism, Amniotic embolism-unspec, Embolism, Amniotic Fluid [Disease/Finding], amniotic embolism fluid, amniotic fluid embolus, Amniotic fluid embolism, unspecified as to episode of care or not applicable, Amniotic Fluid Embolism Syndrome, Amniotic fluid embolism, Amniotic fluid embolism (disorder), embolism; amniotic fluid, embolism; obstetric, amniotic fluid, obstetric; embolism, amniotic fluid, amniotic fluid; embolism, obstetric, amniotic fluid; embolism, Amniotic Fluid Embolism
French EMBOLIE AMNIOTIQUE, Embole de liquide amniotique, Embolie du liquide amniotique, Embolie amniotique, épisode de soins non précisé, Embolie amniotique, Embolie de liquide amniotique
Swedish Fostervattenemboli
Dutch vruchtwaterembolie, vruchtwaterembolie, niet-gespecificeerd naar behandelperiode, embolie; obstetrisch, vruchtwater, embolie; vruchtwater, obstetrisch; embolie, vruchtwater, vruchtwater; embolie, obstetrisch, vruchtwater; embolie, Embolie, vruchtwater-, Vruchtwaterembolie
German Fruchtwasserembolie, ohne Angabe der Behandlungsepisode, Fruchtwasserembolie, Embolie, Fruchtwasser, Embolie, Fruchtwasser-
Italian Embolo di liquido amniotico, Embolia da liquido amniotico, episodio di cura non specificato, Embolia da liquido amniotico
Portuguese Embolimo de líquido amniótico, episódio de cuidados NE, Êmbolo de líquido amniótico, Embolismo de líquido amniótico, EMBOLO DE FLUIDO AMNIOTICO, Embolia Amniótica
Spanish Embolia de líquido amniótico, Embolia de fluido amniótico, Embolia de líquido amniótico, sin especificación del episodio de asistencia, Embolia del líquido amniótico, Embolia de Líquido Amniótico, embolia de líquido amniótico (trastorno), embolia de líquido amniótico, embolismo de líquido amniótico
Japanese ﾖｳｽｲｿｸｾﾝ, ﾖｳｽｲｿｸｾﾝｼｮｳ, 羊水塞栓症, 塞栓症-羊水, 羊水塞栓, 羊水栓塞, 羊水栓塞症
Czech embolie plodovou vodou, Embolie plodovou vodou, Embolie plodovou vodou, bez určení vztahu k péči
Finnish Lapsivesiembolia
Russian EMBOLIIA OKOLOPLODNYMI VODAMI, ЭМБОЛИЯ ОКОЛОПЛОДНЫМИ ВОДАМИ
Korean 양수 색전증
Croatian AMNIJSKA EMBOLIJA, EMBOLIJA PLODNOM VODOM
Polish Zator wodami płodowymi
Hungarian Magzatvíz-embolisatio, a terhesgondozás időszaka szerint nem meghatározott, Magzatvíz-embolisatio, Embolus, amnion folyadék, Magzatvíz embolus
Norwegian Fostervannsemboli
Derived from the NIH UMLS (Unified Medical Language System)

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