This document discusses amniotic fluid embolism (AFE), a rare but life-threatening complication of pregnancy and delivery. It was once associated with an 85% maternal mortality rate, but modern intensive care has reduced the mortality rate to around 35%. AFE is caused by an anaphylactoid reaction when amniotic fluid enters the mother's bloodstream, causing widespread vasoconstriction and cardiac issues. Risk factors include multiparity, abruption, intrauterine fetal death, and certain labor/delivery complications. Diagnosis is clinical but tests like blood gases, ECG, and lung CT can help. Aggressive management focuses on airway control, fluid resuscitation, controlling hemorrhage,

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