View source for Amniotic fluid embolus

==Background==
*Maternal mortality rate ~80%
*85% of survivors have neurologic sequelae
*Occurs in 2-8 per 100,000 deliveries<ref>Fong A, Chau CT, Pan D, et al. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. 2014 Jun 30. 1-6.</ref>
**Responsible for ~10% of maternal mortality in US

===Risk Factors===
*Cesarean delivery
*Advanced maternal age
*Abnormal placental implantation
*Uterine rupture
*[[Eclampsia]]
*Amniocentesis
*Trauma

==Clinical Features==
*Typically occurs during labor and delivery or 30 minutes after delivery
*Any of the following:
**[[Respiratory distress]]
**[[Pulmonary edema]]
**[[Hypoxia]]
**[[Altered mental status]]
**[[Seizures]]
**Sudden maternal [[shock|cardiovascular collapse]]
**[[DIC]]

==Differential Diagnosis==
{{Postpartum emergencies DDX}}

==Evaluation==
[[File:PMC3030025 kjae-59-S158-g001.png|thumb|Post cesarean [[chest X-ray]] in a patient with acute amniotic fluid embolus.]]
[[File:PMC2843707 1752-1947-4-55-2.png|thumb|[[Chest X-ray]] with diffuse infiltration throughout the lungs in a patient with acute amniotic fluid embolus.]]
[[File:PMC2843707 1752-1947-4-55-1.png|thumb|Chest CT showing homogeneous ground-glass opacities in a patient with acute amniotic fluid embolus.]]
*Diagnosis of exclusion
*Consider [[CXR]] and/or chest CT

==Management==
*Treat hypoxia (may require intubation)
*Treat hypotension → [[Pressors]] / [[blood products]]
*Avoid hypoperfusion → Place patient in left lateral decubitus position
*Immediate delivery of fetus → Emergent c-section
**[[Resuscitative hysterotomy]] within 5min of cardiac arrest if mother cannot be resuscitated
===A-OK Medications===
''Only case reports have described the following three therapies''<ref>Rezai S. et al. Atypical Amniotic Fluid Embolism Managed with a NovelTherapeutic Regimen Case Reports in Obstetrics and Gynecology. 2017. https://www.researchgate.net/profile/Shadi_Rezai/publication/312332674_Atypical_Amniotic_Fluid_Embolism_AFE_Managed_With_A_Novel_Therapeutic_Regimen/links/5a3b50da458515a77aa99a21/Atypical-Amniotic-Fluid-Embolism-AFE-Managed-With-A-Novel-Therapeutic-Regimen.pdf</ref>
#[[Atropine]] - 1mg IV 
#*Vagolytic properties may help
#[[Ondansetron]] 8 mg IV
#*Blocking of serotonin receptors can  inhibits the release of more inflammatory mediators.
#[[Ketorolac]] - 30mg IV
#*Can block thromboxane production and prevent coagulopathies.

==Disposition==
*Admit

==See Also==
*[[Postpartum emergencies]]

==References==
<references/>

[[Category:OBGYN]]