AMNIOTIC FLUID EMBOLISM

Abdul Hamid ALRaiyes

History

• 1941 the "classic" description by Steiner & Lushbaugh of amniotic fluid embolism (AFE)

INCIDENCE

1:8000-1: 80 000

mortality is high

IN UK it is implicated in 10-12% of direct maternal deaths

PREDISPOSING FACTORS

1. older age

2. multiparicity

3. forceful labour

4. induction of labour

5. fetal macrosomia

6. placental abruption.

PATHOPHYSIOLOGY

forceful contractions

entry of amniotic fluid into the maternal circulation

pulmonary vascular obstruction

ventricular failure and cardiovascular collapse

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

entry of a trigger

not yet identified into

the maternal bloodstream

causing release of inflammatory

mediators and collapse similar to

that seen in anaphylaxis and sepsis

PATHOPHYSIOLOGY

• triggers

1. Amniotic fluid

2. meconium

3. fetal cells

FEATURES

1. sweating

2. shivering

3. convulsions

4. fetal bradycardia

5. dyspnoea

6. cyanosis

7. cardiovascular collapse

8. DIC

DIFFERENTIAL DIAGNOSIS

1. pulmonary (thrombo)embolism 2. air embolism 3. aspiration pneumonitis 4. Eclampsia5. local anaesthetic toxicity 6. stroke 7. left ventricular failure 8. sepsis 9. haemorrhagic shock 10.anaphylaxis

DIAGNOSIS

• The syndrome is a clinical diagnosis

• identifying fetal squamous cells in the pulmonary vasculature

• identification of fetal antigens in the

maternal circulation or lung tissue.

MANAGEMENT

Supportive

PROGNOSIS

mortality 60-80%

fetal loss 40%

SUMMARY

• AFE unpredictable and lethal complication

of pregnancy

"anaphylactoid syndrome of pregnancy"

REFERENCES

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