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Amniotic Fluid Embolism

Amniotic Fluid Embolism. Dr Max Brinsmead PhD FRANZCOG September 2012. Amniotic Fluid Embolism. A rare event – 3.3 per 100,000 deliveries in an Australian study based on ICD10 Was once associated with an 85% maternal mortality - 50% within the first hour

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Amniotic Fluid Embolism

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  1. Amniotic Fluid Embolism Dr Max Brinsmead PhD FRANZCOG September 2012

  2. Amniotic Fluid Embolism • A rare event – 3.3 per 100,000 deliveries in an Australian study based on ICD10 • Was once associated with an 85% maternal mortality - 50% within the first hour • 35% maternal mortality with modern intensive care and 32% perinatal mortality if it occurs before delivery

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

  4. AFE - Pathophysiology • Probably an anaphylactoid-type reaction to the intravascular ingress of amniotic fluid • This causes widespread vasoconstriction including pulmonary and cardiac vessels • There is ↓myocardial contractility and acute left heart failure • If the mother survives the initial cardiorespiratory failure then DIC and haemorrhage is inevitable • Survivors may suffer stroke due to cerebral infarction • The presence of fetal amniotic squames in the maternal lung at autopsy is said to be “diagnostic”

  5. 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 post partum haemorrhage

  6. AFE – Diagnosis • The diagnosis is a clinical one • Exclude alternatives (if possible) • Placental abruption • Uterine rupture • Eclampsia • Thromboembolism • Cardiogenic causes of acute CCF • Drug toxicity e.g. Local anaesthetics • Anaphylaxis • Transfusion reaction • Massive aspiration of gastric contents • Useful Tests • Blood gases • ECG • Blood Coagulation tests • Lung CT to look for signs of thromboembolism • Serum zinc coproporphyrin >35 nmol/L

  7. AFE - Management • Remember A, B, C • Endotracheal intubation and IPPV with 100% O2 ASAP • Aggressive fluid replacement preferably with CVP monitoring • Aggressive use of oxytocic agents plus whatever to control PPH • Pressor agents eg Dopamine usually required • Multidisciplinary Intensive Care (including a haematologist) • FFP and Platelets for DIC • ?Heparin ?Factor VIIa

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