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AMNIOTIC FLUID AND AMNIOTIC FLUID EMBOLISM, Liquoir Amnii.pptx
- 1. AMNIOTIC FLUID EMBOLISM FROM: YASH PAWAR BASIC BSC NURSING 4TH YEAR
- 3. INTRODUCTION Amniotic fluid is also called liquor amnion It is covered be two layer ,the inner most layer is amnion and the outer most layer is chorion
- 5. DEFINITION Amniotic fluid is a clear protective fluid which are protect the baby and provide favorable environment for survival to fetus and it is 99% consist of water and 1% is is consist of organic,non organic,harmone,vernix caseosa,lanugo and exfoliated fetal cells
- 6. Amount: 50 ml at 12 week 400 ml at 20 week Reaches to its peak of 1 liter at 36-38 week and finally starts diminishing afterwards and it about 600-800 ml at term. CHARACTERISTICS
- 7. Specific gravity: 1.010 Osmolarity: 250 mOsm/L suggests fetal maturity Color: In early pregnancy- colorless, near term- pale straw color due to the presence of exfoliated lanugo and epidermal cells, may look turbid due to vernix caseosa CHARACTERISTICS
- 8. pH:Alkaline in nature Composition:99% water, 1 % is organic, inorganic subs., hormones, lanugo, vernix caseosa, exfoliated fetal cells Replaced in every 3 hours CHARACTERISTICS
- 11. ABNORMAL COLOUR OF AMNIOTIC FLUID
- 12. 1-12 weeks = Ultrafiltration of maternal plasma 12-20 weeks - Fetal skin across the membranes (Keratinization at 22 to 25 weeks) 18 weeks onwards = Fetal urine output (Fetal urine production by 12 weeks) SOURCE
- 13. . During Pregnancy • Shock absorber • Maintains even temperature • Allows the growth of fetus and its movement within the amniotic cavity • Adequate water supply with minimal nutritive value FUNCTION
- 14. During Labor • Helps in dilatation of cervix • Prevents interference with placental circulation during uterine contraction • Prevents umbilical cord compression • Flushes the birth canal to prevent ascending infection into uterine cavity at first stage of FUNCTION
- 15. Fluid production at term - 1. Fetal Urine output (At term - 650-1000 ml/day) 2. Fetal lung secretion (350 ml / day) REGULATION/CIRCULATION
- 16. Fluid resorption at term - 1. Fetal swallowing (Swallowing begins by 10-12 weeks) (At term 500-1000 ml) 2. Intramembranous flow - (400 ml /day) REGULATION/CIRCULATION
- 17. Amniotic fluid is measured by two methods • Amniotic fluid index;in the method the uterus is divided into four quadrants and the measurements of each quadrants Added And done by ultrasonography.A normal amniotic fluid index is 5 cm to 25 cm using the standard assessment method. Less than 5 cm is considered oligohydramnios, and greater than 25 cm is considered polyhydramnios. Amniotic Fluid Measurement
- 18. • Single deepest pocket:in this method the measurements are done by ultrasonography in which measure the one quadrant deepth • . 2-8cm is normal range Amniotic Fluid Measurement
- 24. INTRODUCTION • 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
- 25. DEFINITION This is a condition when amniotic Fluid is forced into the maternal circulation via uterus or placental site forming a embolism which obstructs pulmonary vessels leading to respiratory distress and circulatory collapse ,the amniotic fluid may contain vernix ,hair,foetal squamous cells or epithelium
- 26. RISK FACTORS 1. Advanced maternal age 2. Placental problems 3. Preeclampsia 4. Madically induced labour 5. Operative delivery 6. Polyhydramnios
- 27. RISK FACTORS 1. Multipara 2. C/section 7 operative delivery 3. Placental abruption, fetal death 4. • 80% in labour 5. 20% before or after birth
- 28. SIGN AND SYMPTOMS • Abrupt onset of respiratory distress • Chest pain • Seizures • Heart failure • Pulmonary oedema • Fetal bradycardia • Feral distress,if delivery had not yet occured
- 29. SIGN AND SYMPTOMS • Dramatic • Rapid progression from dyspnoea, hypotension & cardiac arrest • Seizures, coma • Haemorrhage • Fetal distress
- 30. WHAT WOMEN REPORT • Breathlessness • Feling of doom(anxiety) • Chest pain • Feeling cold • Light headed • Pins and needles • Restlessness, sense of panic • Nausea and vomiting
- 32. PATHOPHYSIOLOGY • Probably an anaphylactoid-type reaction (potentially life-threatening allergic reaction)to the intravascular ingress of amniotic fluid • This causes widespread vasoconstriction including pulmonary and cardiac vessels • There is myocardial contractility and acute left heart failure • If the mother survives the initial cardiorespiratory failure then DIC and haemorrhage is inevitable
- 33. • Survivors may suffer stroke due to cerebral infarction • The presence of fetal amniotic squames in the maternal lung at autopsy is said to be "diagnostic"
- 35. Investigations • Coagulation profile: AFE is associated with DIC in >80% cases • Electrocardiogram shows tachycardia, ST segment and T-wave changes, and findings consistent with right ventricle strain
- 36. NORMAL XRAY
- 37. AFE
- 38. • Arterial blood gases: changes consistent with hypoxia • Chest X-ray: consistent with pulmonary edema • Echocardiogram • Serum tryptaseaining Investigations
- 39. Management • Intensive care monitoring • . One should be aware that there is high- risk at developing: ARDS, heart failure, DIC • Supportive treatment: Ventilation, inotropic support, Hematological support • Steroids may be useful
- 40. Midwifery Nurse Action • 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
- 41. Potential Interventions for Severe Life Threatening Cases of AFE • Inhaled nitric oxide for pulmonary hypertension leading to right-sided heart failure • ECMO for severe hypoxia and left heart failure.
- 42. THANKING YOU