Amniotic Fluid Embolism

What is an amniotic fluid embolism?

Amniotic fluid embolism (AFE) is a rare and incompletely understood obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother’s blood stream via the placental bed of the uterus and trigger an allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and coagulopathy. It was first formally characterized in 1941.

The scenario described above described leads to spasm of the pulmonary (lung) blood vessels leading to lack of oxygen and therefore hypoxia. The Patient sometimes experiences seizures as well. Hypoxia leads to heart failure and lung damage, and can lead to Adult Respiratory Distress Syndrome (ARDS). The next step or the progression of this unfortunate disease is hypovolaemia, usually caused by bleeding from the Uterus, caused by coagulopathy/ hemorrhage, often leading to cardiac arrest, which is often lethal.

Up to 50% of Patients die within the first hour after the onset of their symptoms. The survival rate is as low as 15%.

  • What are the risk factors of Amniotic Fluid Embolism?
  • What is the treatment?
  • What happens in ICU?
  • How long will your loved one remain in ICU?
  • References

 

What are the risk factors of Amniotic Fluid Embolism?

Amniotic Fluid Embolism may occur in healthy women during labour, during caesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post delivery. Identified risk factors include:

  • Older maternal age
  • Multiparity (more than one child)
  • Intense contractions during labour
  • Abdominal trauma
  • Cesarean section
  • Tears in the uterus or cervix
  • Early separation of the placenta from the uterus wall
  • Intestinal material from the foetus entering the woman’s blood stream
  • Foetal distress
  • Foetal death
  • Male baby

What is the treatment of Amniotic Fluid Embolism?

The treatment is responsive and supportive. If the Patient has heart failure leading to a cardiac arrest, cardiopulmonary resuscitation (CPR) will be commenced. If the woman does not respond to resuscitation and CPR, an emergency Cesarean section will be performed after the mother has died. The foetus will be monitored closely for signs of distress. There is no known prevention a pregnant woman can do having an amniotic fluid embolism.

What happens in ICU?

  • Your loved one will be monitored with a Bedside Monitors where heart rate& heart rhythm, blood pressure, respiratory rate, oxygen saturation and temperature will be monitored.
  • your loved one will require an Arterial Catheter for haemodynamic/blood pressure monitoring and for regular Blood& Pathology tests in Intensive Care
  • Infusion pumps are administering drugs to support your loved ones blood pressure and haemodynamic system, as well as intravenous fluids may be administered via a central venous catheter/ CVC(Central Venous Lines).
  • Blood products such as Red blood cells, including fresh frozen plasma(FFP’s), cryoprecipitate, and platelets may be given for abnormal blood clotting (coagulopathy) and to replace any blood lost through severe bleeding.
  • Ventilators (Breathing Machines) usually initiate Mechanical ventilation via a Breathing Tube (endotracheal tube) as the Patient is usually so sick that mechanical ventilation is required. Once the Patient is ventilated he or she will require suctioning to remove secretions from the lungs.
  • An NG Tube (Nasogastric Tubes) is usually inserted into your loved ones stomach, in order to commence nutrition or to remove fluids.
  • Urine Output is usually measured hourly, after insertion of a Urinary Catheter
  • Chest X-ray and other pathology tests such as blood tests, CT scan, MRI, echocardiogram, electrocardiogram (ECG), and urine tests may be carried out in order to get a definitive diagnosis.
  • Your loved one is placed on an air or a soft mattress, to prevent any pressure injuries

How long will your loved one remain in Intensive Care?

The prognosis after Amniotic Fluid Embolism is very poor, and most women do not survive. If your loved one survives the ordeal, there is a risk of them having a hypoxic brain injury (brain damage) as a result of the lack of oxygen to the brain. Please ask the ICU nurse or doctor if you have any questions about your loved one.

References

emedicine: Amniotic Fluid Embolism
Women’s Health Au

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.

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