Amniotic fluid embolus: Difference between revisions
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*Maternal mortality rate ~80% | *Maternal mortality rate ~80% | ||
*85% of survivors have neurologic sequelae | *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=== | ===Risk Factors=== | ||
Revision as of 05:42, 12 October 2018
Background
- Maternal mortality rate ~80%
- 85% of survivors have neurologic sequelae
- Occurs in 2-8 per 100,000 deliveries[1]
- 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 cardiovascular collapse
- DIC
Differential Diagnosis
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Evaluation
- Diagnosis of exclusion
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
Disposition
- Admit
See Also
References
- ↑ 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.