AFE

1. AMNIOTIC FLUID EMBOLISM
MRS. DEEPTI KUKRETI
PG NURSING TUTOR
OBSTETRICS& GYNAECOLOGY

2. AMNIOTIC FLUID EMBOLISM
DEFINITION
• Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency.
• It happens due to sudden gush of amniotic fluid ,fetal cells , hair and amniotic
debry entering the maternal circulation.
• Signs and Symptoms:
1. Sudden collapse due to profound hypotension.
2. Hypoxemia
3. DIC (Disemminated intravascular coagulation)

3. Differential Diagnosis Obstetric Causes
• Acute hemorrhage
• Amniotic fluid embolism
• Placental abruption
• Uterine rupture
• Uterine atony
• Eclampsia
• Peripartum cardiomyopathy
Anesthetic Causes
• High spinal anesthesia
• Aspiration
• Local anesthetic toxicity
Non obstetric Causes
• Pulmonary embolism
• Air embolism
• Anaphylaxis
• Sepsis/septic shock
• Intracerebral bleed
• Drug toxicity
• Acute myocardial infarction

4. Factors that may be associated withAFE
• Advanced maternal age
• Multiparity
• Meconium stained liquor
• Obstructed labor
• Intrauterine fetal death
• Polyhydramnios
• Tetanic uterine contractions
• Maternal history of allergy or atopy
• Uterine rupture
• Placenta accreta
• Trauma
• Diabetes mellitus
• Operative delivery including cesarean section.

5. Symptoms Signs
Dyspnea Hypotension
Cough Fetal Distress
Headache Pulmonary edema/ARDS
Chest Pain Cyanosis
Coagulopathy
Seizures
Bronchospasm
Cardiopulmonary arrest
UterineAtony
CLINICAL
FEATURES

6. Treatment
• Management is symptomatic and supportive.
• Targets- Maintaining oxygenation ,hemodynamic support and
correction of coagulopathy
• Immediate Resuscitation-ABC
 Airway and breathing
• Administer 100% oxygen via a non-rebreathing reservoir face
mask
• Prompt assessment, with control of the airway and ventilation
of the lungs with tracheal intubation may be essential.
 Circulation
• 2 large bore iv lines, send blood for coagulation profile, CBC,
crossmatch, arrange 6units blood.
• Left lateral tilt/Manual uterine displacement.
• Hemodynamic support would include preload optimization and
vasopressors.

7. • Fluid resuscitation with crystalloid/colloid to optimize filling.
• Infusion of an inotrope may be required to maintain a mean arterial blood pressure
and achieve an adequate urine output.
• An arterial line for continuous blood pressure monitoring is essential, and the use
of a non-invasive cardiac output monitor may be helpful.
• Continuously monitor the fetus and early consideration should be given to delivery
of baby.
 Uterine tone –Pharmacologic agents such as oxytocin, ergometrine and
prostaglandins carboprost and misoprost.
 Coagulation:
• Use of plasma, cryoprecipitate, and platelets to be guided by clinical condition of
the patient and laboratory investigations.
• Recombinant factor VII may be used, but one should be careful as this can cause
thrombotic complications
 Antifibrinolytics, like e-aminocaproic acid and tranexamic acid, might be helpful
but evidence is lacking.

8. 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
• Arterial blood gases: changes consistent with hypoxia
• Chest X-ray: consistent with pulmonary edema
• Echocardiogram
• Serum tryptase

9. 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
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.

10. THANK YOU