Amniotic Fluid Embolism

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Amniotic Fluid Embolism is one of the most devastating obstetric emergencies yet least understood. This presentation briefly outlines this condition

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Amniotic Fluid Embolism

  1. 1. Amniotic Fluid Embolism Sarah Stewart 2011 Creative Commons Attribution Licence
  2. 2. Amniotic Fluid Embolism (AFE) <ul><li>Rare and catastrophic </li></ul><ul><li>1: 8,000 to 1: 30,000 pregnancies, but difficult to confirm </li></ul><ul><li>Can not be predicted or prevented from occurring </li></ul><ul><li>13 - 86% maternal mortality </li></ul><ul><li>50% of deaths in the first hour, many from cardiac arrest </li></ul><ul><li>Most develop DIC </li></ul><ul><li>Survivors usually have major neurological problems </li></ul><ul><li>Often isn't diagnosed until autopsy </li></ul><ul><li>20 - 40% neonatal mortality; half of survivors have neurological damage </li></ul>
  3. 3. Why does AFE occur? <ul><li>Unknown </li></ul><ul><li>Amniotic fluid (& its fetal components: cells, lanugo, vernix) enters the maternal circulation (pulmonary oedema, respiratory distress, increased pressure in heart, damage to heart muscle, decreased cardiac output) </li></ul><ul><li>? Torn placental membrane / ? Ruptured uterine vein </li></ul><ul><li>? Associated with hypertonic uterus </li></ul><ul><li>? Anaphylactic syndrome of pregnancy (40% AFE women had History of Atopy / allergy) </li></ul>
  4. 4. Risk factors <ul><li>? Association between AFE and Oxytocin induction of labour and/or ARM </li></ul><ul><li>Multiparity </li></ul><ul><li>Advanced maternal age? </li></ul><ul><li>C/section 7 operative delivery </li></ul><ul><li>Placental abruption, fetal death </li></ul><ul><li>80% in labour </li></ul><ul><li>20% before or after birth </li></ul>
  5. 5. Manifestation <ul><li>Dramatic. </li></ul><ul><li>Rapid progression from dyspnoea, hypotension & cardiac arrest </li></ul><ul><li>Seizures, coma </li></ul><ul><li>Haemorrhage </li></ul><ul><li>Fetal distress </li></ul>
  6. 6. What women report <ul><li>Breathlessness </li></ul><ul><li>Feeling of doom </li></ul><ul><li>Chest pain </li></ul><ul><li>Feeling cold </li></ul><ul><li>Light headed </li></ul><ul><li>Pins and needles </li></ul><ul><li>Restlessness, sense of panic </li></ul><ul><li>Nausea and vomiting </li></ul>
  7. 7. Normal x-ray
  8. 8. http://www.learningradiology.com/archives2008/COW%20290-Amniotic%20Fluid%20Embolism/amnioticfluidccorrect.html AFE
  9. 9. Midwifery Actions <ul><li>Get emergency help quickly </li></ul><ul><li>Initiate CPR </li></ul><ul><li>Oxygen </li></ul><ul><li>Treat shock, IV fluids </li></ul><ul><li>Emergency caesarean </li></ul><ul><li>Transfer to ICU </li></ul><ul><li>Support and care for woman and family in emergency / shock situation </li></ul>
  10. 10. Reference <ul><li>Thoroughgood, C. (2010). Life-threatening emergencies. In S. Pairman, S.Tracy, C. </li></ul><ul><li>Thoroughgood, & J. Pincombe (Eds.), Midwifery. Preparation for practice (pp 909 </li></ul><ul><li>-970). Edinburgh: Elsevier. </li></ul>

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