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Amniotic Fluid Embolism
Aka: Amniotic Fluid Embolism, Pulmonary Embolism of Amniotic Fluid, Anaphylactoid Syndrome of Pregnancy
- See Also
- Pulmonary Embolism in Pregnancy
- Pulmonary Embolism
- Epidemiology
- Incidence: 1 in 8000 to 80,000 live births
- Pathophysiology
- Amniotic fluid released into maternal circulation
- Amniotic fluid induces anaphylactoid-type immunologic response
- Results in transient pulmonary artery spasm
- Causes Hypoxia, pulmonary capillary injury and left ventricular injury
- Results in Left Ventricular Failure, ARDS, DIC and multi-system failure
- Symptoms
- Severe, sudden onset Dyspnea
- Signs
- Tachypnea
- Hypoxia
- Severe shock of rapid onset
- Altered Mental Status or encephalopathy
- Cyanosis
- Hypotension
- Cardiopulmonary arrest
- Risk Factors
- Trauma in Pregnancy
- Amniotomy
- Strong uterine contractions
- Differential Diagnosis
- Pregnancy Induced Hypertension
- Abruptio Placentae
- Uterine Rupture
- Aspiration Pneumonia
- Lab
- Arterial Blood Gas
- Complete Blood Count with Platelets
- Thrombocytopenia
- Urinalysis
- Type and Cross 4-6 units Packed Red Blood Cells
- Coagulation studies
- D-Dimer
- ProTime (PT, INR)
- Partial Thromboplastin Time (PTT)
- Fibrin split products (Fibrin Degradation Products)
- Fibrinogen (low)
- Clot Test
- Imaging
- Chest XRay
- Bilateral infiltrates may be seen with progression
- Diagnostics
- Electrocardiogram (EKG)
- Sinus Tachycardia
- Dysrhythmias
- Management
- Emergent supportive care
- Oxygen Supplementation
- Intravenous Access
- Endotracheal Intubation
- Vasopressors
- Fluid Resuscitation
- Correct coagulation deficits
- Advanced Measures to consider
- Venoarterial ECMO
- Uterine Artery Embolization
- Exchange Transfusion
- A-OK Amniotic Fluid Embolism Protocol
- Atropine 1 mg IV (vagolytic) AND
- Ondansetron 8 mg IV (Serotonin blockade) AND
- Ketorolac 30 mg IV (thromboxane production blockade)
- Rezai (2017) Case Rep Obstet Gynecol +PMID: 29430313 [PubMed]
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753013/
- Admit to Intensive Care unit
- Consultations
- Maternal-fetal medicine
- Medicine
- Neonatology
- Monitoring
- Check Hemoglobin every 1 hour (keep above 10 mg/dl)
- Check Hematocrit every 1 hour (keep above 30)
- Check coagulation studies every 2 hours
- Fetal scalp electrode
- Tocometry or intrauterine pressure catheter
- Monitor strict intake and output
- Keep Urine Output > 30 cc per hour
- Prognosis
- Mortality approaches 61% for mothers
- Low survival rate for fetus if still in utero
- Surviving mothers have intact neurologic function in only 15% of cases
- References
- Krywko and Jennings (2018) Crit Dec Emerg Med 32(4): 3-11
- Lively and Clare (2022) Crit Dec Emerg Med 36(5): 4-10
- Clark (1995) Am J Obstet Gynecol 172(4): 1158-69 [PubMed]