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Amniotic Fluid Embolism

1) Amniotic fluid embolism is a complication of pregnancy and labor where amniotic fluid enters the maternal circulation, potentially causing pulmonary embolism, shock, coagulopathy and death. 2) It occurs when there is a breach in the maternal veins or blood sinuses of the cervix or uterus allowing amniotic fluid to enter the circulation. 3) Management involves treating pulmonary hypertension, shock, disseminated intravascular coagulation and acute renal failure which can result from amniotic fluid embolism.

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1K views19 pages

Amniotic Fluid Embolism

1) Amniotic fluid embolism is a complication of pregnancy and labor where amniotic fluid enters the maternal circulation, potentially causing pulmonary embolism, shock, coagulopathy and death. 2) It occurs when there is a breach in the maternal veins or blood sinuses of the cervix or uterus allowing amniotic fluid to enter the circulation. 3) Management involves treating pulmonary hypertension, shock, disseminated intravascular coagulation and acute renal failure which can result from amniotic fluid embolism.

Uploaded by

Star Alvarez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
  • Amniotic Fluid Embolism Introduction: Begins with a broad understanding of Amniotic Fluid Embolism and its significance.
  • Definition: Provides a definition of Amniotic Fluid Embolism, describing it as a complex disorder affecting maternal circulation.
  • Overview: Summarizes key features and risks associated with Amniotic Fluid Embolism, highlighting mortality rates and occurrences.
  • Mechanism Inquiry: Poses the question about how amniotic fluid enters maternal circulation, leading into the etiology discussion.
  • Etiology: Discusses the causes and factors contributing to the condition, like high pressure or fetal membrane disruption.
  • Outcome of Fluid Entry: Explores the consequences of amniotic fluid entering maternal circulation, such as shock and other physiological reactions.
  • Pathophysiology: Explains the physiological changes and responses that occur during an embolism incident.
  • Clinical Presentation: Describes typical and atypical clinical presentations of the embolism in affected individuals.
  • Diagnosis: Outlines diagnostic methods and preliminary diagnosis procedures to quickly identify amniotic fluid embolism.
  • Laboratory Examination for DIC: Details laboratory tests used to examine disseminated intravascular coagulation linked to the condition.
  • Management Overview: Introduces overall management strategies to address the symptoms and complications of the condition.
  • Treatment: Hypoxia Reduction: Focuses on treatments aimed at reducing pulmonary hypertension and improving oxygenation in patients.
  • Treatment: Anti-Anaphylaxis: Discusses the use of corticosteroids to counter allergic reactions associated with embolism events.
  • Treatment: Shock Prevention: Lists treatments that aim to prevent and mitigate shock resulting from the embolism.
  • Treatment: DIC Prevention: Outlines strategies for minimizing and managing disseminated intravascular coagulation during an embolism.
  • Treatment: ARF and Infection: Addresses treatments for preventing acute renal failure and infections linked to the condition.
  • Obstetric Management: Provides a decision flowchart for obstetric management before, during, and after amniotic fluid embolism events.
  • Prevention: Explains prevention strategies to reduce the risk of triggering an amniotic fluid embolism.
  • Conclusion: Concludes the presentation with a closing note of gratitude.

Amniotic Fluid Embolism

Womens Hospital School of Medicine Zhejiang


University
Wang Zhengping

Definition
Amniotic Fluid Embolism is a complex disorder
during labor characterized by amniotic fluid
entering into the maternal circulation which
causes acute pulmonary embolism, shock,
DIC, acute renal failure or abrupt death.

overview

An devastating complication during labor


Mortality: up to 60%~80%
May occur in the first and second trimester
abortions
Recently, it is also termed anaphylactoid
syndrome of pregnancy

Why amniotic fluid can enter into the


maternal circulation?

Etiology :Three factors

There is a breach in vein or blood sinus at the


trauma site of cervix and the body of uterine
Higher pressure of amniotic cavity
Disruption of fetal membrane

amniotic fluid enters into the maternal circulation


through the breached vein and blood sinus

What would happen


after the amniotic fluid enter into
the maternal circulation

pathophysiology
Amniotic fluidinferior vena atrio dextro
right ventricle pulmonary artery

Pulmonary artery hypertension


Allergic shock
DIC
Acute renal failure(ARF)

Clinical presentation
Acute amniotic fluid embolism: occur acutely
Pulmonary artery
Typical: three phages

hypertension/ Shock
Hemorrhage due to DIC

Atypical:

Acute renal failure


Bulk colporrhagia
(occur mainly after delivery)
shock

Diagnosis

According to the typical clinic manifestation, we can


make the preliminary diagnosis and save the
patients immediately
While saving the patients do the necessary auxiliary
examination, including:
a. Collecting blood from arteria pulmonalis and inferior
vena, and finding components of amniotic fluid
b. The basis of laboratory examination for DIC
c. ECG
d. X-ray
e. Autopsy

Basis of laboratory examination for DIC

PLT 100 109/L or it was gradually decrease


fibrinogen <1.5g/L
PT >15 s
plasm protamine paracoagulation test (+)
Obtrite RBC in blood smear

Management

Improve hypoxia
Anti-anaphylacic shock
Prevent DIC and acute renal failure(ARF)
Prevent infection

Treatment
1 Disengage pulmonary hypertension,
improve hypoxia:
Oxygenation
Anticonvulsive drug

Aminophylline
Narceine
Atropine
phentolamine

Treatment
2 Anti-anaphylacic
Hydrocortisone

Glucocorticosteroid

Dexamethasone

Treatment
3 Anti-shock
Transfusion
Angiotensin
Treat heart failure
Cure acidemia

Treatment
4 Prevent and cure
DIC

Use decoagulant and heparin as early as


possible

Treatment
5 Prevent or cure ARF and infection

Prevent ARF:
aware of urinary
volume
Furosemide

Prevent infection
using antibiotic drug
with low toxicity

Treatment
6 Obstetric management
intrapartum
antepartum

post partum

amnionic fluid embolism


drug treatment
Cervical apertura is not open
or not fully open

cesarean section delivery


Without hemorrage
Go on the expectant treatment

Cervical apertura
is fully dilatting

Forcep delivery

Without postpartum
hemorrhage

postpartum hemorrhage
uterectomy

Go on the expectant treatment

Prevention

Artificial rupture of membrane without stripping of membrane


Dont conduct artificial rupture of membrane when uterine is
constricting
Master the indication of oxytocin application
Protect the vessel during the caesarean section
Avoid precipitate labor, birth trauma, rupture of uterus,
cervical laceration
Aware of the predisposing factor

Amniotic Fluid Embolism Women’s Hospital School of Medicine Zhejiang University Wang Zhengping
Definition Amniotic Fluid Embolism is a complex disorder during labor characterized by amniotic fluid entering int
overview An devastating complication during labor Mortality: up to 60%~80% May occur in the first and second trimester
Why amniotic fluid can enter into the maternal circulation?
Etiology :Three factors There is a breach in vein or blood sinus at the trauma site of cervix and the body of uterine 
What would happen after the amniotic fluid enter into the maternal circulation
pathophysiology Pulmonary artery hypertension Allergic shock DIC Acute renal failure(ARF) Amniotic fluid→inferior ven
Clinical presentation Acute amniotic fluid embolism: occur acutely Pulmonary artery hypertension/ Shock Hemorrhage due t
Diagnosis According to the typical clinic manifestation, we can make the preliminary diagnosis and save the patients
Basis of laboratory examination for DIC PLT ＜100 10 ╳ 9/L or it was gradually decrease fibrinogen <1.5g/L PT >15 s

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