Amniotic Fluid Embolism

1. DR-MAXAMUD C/LAHI QAXIILE
DR KURTUN Oct-2016

2. Amniotic Fluid Embolism
 A rare event – 3.3 per 100,000 deliveries in an
Australian study based on ICD10
 Was once associated with an 85% maternal
mortality - 50% within the first hour
 35% maternal mortality with modern intensive
care and 32% perinatal mortality if it occurs before
delivery

3. AFE – Risk Factors
Multiparity
Abruption
Intrauterine Fetal Death
Tumultuous labour
Oxytocin or Prostaglandin hyperstimulation
Caesarean section
Manual removal of the placenta

4. AFE - Pathophysiology
Probably an anaphylactoid-type 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
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”

5. AFE – Clinical Presentations
Acute fetal distress followed quickly by maternal
collapse with hypotension, dyspnoea and cyanosis
Sudden loss of consciousness or seizure
Often proceeds or occurs immediately after
delivery
Maternal collapse during Caesarean section
Followed by profuse post partum haemorrhage

6. AFE – Diagnosis
The diagnosis is a clinical one
Exclude alternatives (if possible)
Placental abruption
Uterine rupture
Eclampsia
Thromboembolism
Cardiogenic causes of acute CCF
Drug toxicity e.g. Local anaesthetics
Anaphylaxis
Transfusion reaction
Massive aspiration of gastric contents
 Useful Tests
Blood gases
ECG
Blood Coagulation tests
Lung CT to look for signs of thromboembolism
Serum zinc coproporphyrin >35 nmol/L

7. AFE - Management
 Remember A, B, C
 Endotracheal intubation and IPPV with
100% O2 ASAP
 Aggressive fluid replacement preferably
with CVP monitoring
Aggressive use of oxytocic agents plus
whatever to control PPH
 Pressor agents eg Dopamine usually
required
Multidisciplinary Intensive Care (including a
haematologist)
 FFP and Platelets for DIC