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Amniotic Fluid Embolism

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

  • Pathophysiology
  1. Amniotic fluid released into maternal circulation
  2. Amniotic fluid induces transient pulmonary artery spasm
  3. Causes Hypoxia, pulmonary capillary injury and left ventricular injury
  4. Results in Left Ventricular Failure, ARDS, DIC and multi-system failure
  • Signs
  1. Severe shock of rapid onset
  2. Severe, sudden onset Dyspnea
  3. Altered Mental Status
  4. Cyanosis
  5. Hypotension
  6. Cardiopulmonary arrest
  • Risk factors
  1. Trauma in Pregnancy
  2. Amniotomy
  3. Strong uterine contractions
  • Management
  1. Emergent supportive care
    1. Oxygen Supplementation
    2. Intravenous Access
    3. Endotracheal Intubation
    4. Vasopressors
    5. Fluid Resuscitation
    6. Correct coagulation deficits
    7. Consider ECMO
  2. 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/
  3. Admit to Intensive Care unit
  4. Consultations
    1. Maternal-fetal medicine
    2. Medicine
    3. Neonatology
  • 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
  • References
  1. Krywko and Jennings (2018) Crit Dec Emerg Med 32(4): 3-11