Amniotic Fluid Embolism

1. Amniotic Fluid Embolism Anupama Tamrakar, Yenepoya Nursing College

2. Definition • Amniotic Fluid Embolism is a complex disorder during labor characterized by amniotic fluid entering into the maternal circulation through the rent in the membranes or placenta. which causes acute pulmonary embolism, shock, DIC, acute renal failure or abrupt death.

3. overview • An devastating complication during labor • Mortality: up to 60%~80% • May occur in the 1st and 2nd trimester abortions • Recently, it is also termed “anaphylactoid syndrome of pregnancy”

4. Etiology :Three factors • There is a break in vein or blood sinus at the trauma site of cervix and the body of uterine • Higher pressure of amniotic cavity • Disruption of fetal membrane amniotic fluid enters into the maternal circulation through the broken vein and blood sinus

5. AFE – Risk Factors Multiparity Abruption Intrauterine Fetal Death Oxytocin or Prostaglandin hyperstimulation Caesarean section Manual removal of the placenta

6. What would happen after the amniotic fluid enter into the maternal circulation

7. Pathophysiology • Pulmonary artery hypertension • Allergic shock • DIC • Acute renal failure(ARF) Amniotic fluid→inferior vena → rt. atrium → right ventricle →pulmonary artery

8. AFE – Clinical Presentations Acute fetal distress followed quickly by maternal collapse with hypotension, dyspnoea and cyanosis Sudden loss of consciousness or seizure Often proceeds or occurs immediately after delivery Maternal collapse during Caesarean section Followed by profuse PPH

9. Diagnosis • According to the typical clinical manifestation, we can make the preliminary diagnosis and save the patients immediately • While saving the patients do the necessary auxiliary examination, including: a. Collecting blood from arteria pulmonalis and inferior vena, and finding components of amniotic fluid b. The basis of laboratory examination for DIC c. ECG d. X-ray e. Autopsy

10. Basis of laboratory examination for DIC • PLT＜ 100 ╳109/L or it was gradually decrease • fibrinogen <1.5g/L • PT >15 s • plasm protamine paracoagulation test (+) • Obtrite RBC in blood smear

11. Management • Improve hypoxia • Anti-anaphylacic shock • Prevent DIC and acute renal failure(ARF) • Prevent infection

12. Treatment 1、Disengage pulmonary hypertension, improve hypoxia: Oxygenation Aminophylline Narceine Atropine phentolamine Anticonvulsive drug

13. 2、Anti-anaphylacic Treatment • Glucocorticosteroid Hydrocortisone Dexamethasone

14. 3、Anti-shock Treatment • Transfusion • Angiotensin • Treat heart failure • Cure acidemia

15. 4、Prevent and cure DIC Treatment • Use decoagulant and heparin as early as possible

16. Prevent ARF: aware of urinary volume Furosemide Prevent infection using antibiotic drug with low toxicity 5、Prevent or cure ARF and infection Treatment

17. Treatment 6、Obstetric management post partum intrapartum antepartum amnionic fluid embolism drug treatment Cervical apertura is not open or not fully open Cervical apertura is fully dilatting Without postpartum hemorrhage cesarean section delivery Forcep delivery Without hemorrage postpartum hemorrhage Go on the expectant treatment Go on the expectant treatment uterectomy

18. Prevention • Artificial rupture of membrane without stripping of membrane • Don’t conduct artificial rupture of membrane when uterine is constricting • Master the indication of oxytocin application • Protect the vessel during the caesarean section • Avoid precipitate labor, birth trauma, rupture of uterus, cervical laceration • Aware of the predisposing factor

19. Thanks