Amniotic fluid embolus: Difference between revisions
 
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==Background==
==Background==
*Diagnosis of exclusion
*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===
#Cesarean delivery
*Cesarean delivery
#Advanced maternal age
*Advanced maternal age
#Abnormal placental implantation
*Abnormal placental implantation
#Uterine rupture
*Uterine rupture
#[[Eclampsia]]
*[[Eclampsia]]
#Amniocentesis
*Amniocentesis
#Trauma
*Trauma


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


==Differential Diagnosis==
==Differential Diagnosis==
{{Postpartum emergencies DDX}}
{{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==
==Management==
#Treat hypoxia
*Treat hypoxia (may require intubation)
##NRB or intubate
*Treat hypotension → [[Pressors]] / [[blood products]]
#Treat hypotension
*Avoid hypoperfusion → Place patient in left lateral decubitus position
##[[Pressors]] / [[blood products]]
*Immediate delivery of fetus → Emergent c-section
#Avoid hypoperfusion
**[[Resuscitative hysterotomy]] within 5min of cardiac arrest if mother cannot be resuscitated
##Place patient in left lateral decubitus position
===A-OK Medications===
#Immediate delivery of fetus:
''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>
##[[Perimortem C-section]] within 5min of cardiac arrest if mother cannot be resuscitated
#[[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==
==See Also==
*[[Post-Partum Emergencies]]
*[[Postpartum emergencies]]


==References==
==References==
<references/>
<references/>


[[Category:OBGYN]]
[[Category:OBGYN]]

Latest revision as of 12:43, 25 November 2021

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

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Evaluation

Post cesarean chest X-ray in a patient with acute amniotic fluid embolus.
Chest X-ray with diffuse infiltration throughout the lungs in a patient with acute amniotic fluid embolus.
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

A-OK Medications

Only case reports have described the following three therapies[2]

  1. Atropine - 1mg IV
    • Vagolytic properties may help
  2. Ondansetron 8 mg IV
    • Blocking of serotonin receptors can inhibits the release of more inflammatory mediators.
  3. Ketorolac - 30mg IV
    • Can block thromboxane production and prevent coagulopathies.

Disposition

  • Admit

See Also

References

  1. ↑ 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.
  2. ↑ 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
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