Learning Objectives
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Describe the pathophysiology of amniotic fluid embolism.
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List risk factors for amniotic fluid embolism.
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Identify clinical presentation of amniotic fluid embolism.
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Describe a management strategy for amniotic fluid embolism.
Amniotic fluid embolism is a fortunately rare obstetric emergency. However, if mothers are to survive this catastrophic event, clinicians must recognize it quickly and manage it very aggressively.
Pathophysiology
Amniotic fluid embolism occurs when there is enhanced communication between the amniotic cavity and maternal circulation. This allows amniotic fluid to enter the maternal circulation where it triggers a systemic inflammatory response ( Fig. 25.1 ). In the first hour, this typically presents as pulmonary hypertension and right ventricular failure. This is followed by left ventricular failure. The resultant hypotension and hypoxemia trigger multisystem organ failure. Concurrent activation of the coagulation cascade results in disseminated intravascular coagulation.
Risk Factors
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Multifetal gestation
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Advanced maternal age
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Operative delivery
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Eclampsia
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Polyhydramnios
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Cervical laceration
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Uterine rupture
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Placenta previa
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Amnioinfusion
Clinical Presentation
There are no diagnostic tests or laboratory findings for amniotic fluid embolism. It is a clinical diagnosis based on the following findings:
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Sudden, unexplained respiratory distress
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Hypotension
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Cardiac arrest
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Seizure-like activity
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Fetal bradycardia
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Disseminated intravascular coagulation
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Uterine atony
Differential Diagnosis
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Pulmonary embolism
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Congestive heart failure
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Myocardial infarction
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Anaphylaxis
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Placental abruption
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Sepsis with hypotension
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Placental abruption
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Anesthetic complications
Management
The goals of management are stabilization of the mother and rapid delivery of the fetus ( Table 25.1 ).
| Cardiovascular |
|
| Respiratory |
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| Coagulopathy |
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| Delivery |
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