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

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

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