Category Archives: Obstetrics and Perinatology

Amniotic Fluid Embolism

Amniotic fluid embolism (AFE) is a rare but catastrophic complication of pregnancy.

  • Affects an estimated  3 to 5 per 100,000 live births.
  • Mortality rate among affected parturients is as high as 85% and accounts for up to 12% of all maternal deaths.
  • Significant and permanent neurologic sequelae are common among survivors.
  • Introduction of fetal cells, amniotic fluid, and inflammatory mediators in the maternal circulation are thought to be the cause.
  • Presents during labor or the immediate postpartum period with acute hypoxia and hypotension.

Clinical Presentation of AFE:

  •  Hypotension is a key feature of the disease and is present in 100% of patients with severe disease.The initial transient physiologic response is pulmonary hypertension resulting in hypoxia and right heart failure. Patients who survive the initial insult develop a left heart failure and pulmonary edema
  • Hypoxia is an early manifestation of AFE and is thought to arise from acute pulmonary hypertension and ventilation/perfusion mismatch. Pulmonary edema develops later in association with left ventricular dysfunction.
  • Disruption of normal clotting cascade occurs in up to two thirds of patients.

Management of AFE: 

  • Oxygenation: Tracheal intubation, mechanical ventilation, and supplemental oxygen.
  • Circulatory support: Fluid resuscitation and pressor support as needed.
  • Lines and monitors: Normal ASA monitors plus invasive BP, and PA catheter and/or TEE to assess ventricular function.
  • Regular lab studies to aggressively treat coagulopathy.

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