Amniotic fluid embolus: Difference between revisions
(Text replacement - "AMS" to "altered mental status") |
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==Background== | ==Background== | ||
*Maternal mortality rate ~80% | *Maternal mortality rate ~80% | ||
*85% of survivors have neurologic sequelae | |||
===Risk Factors=== | ===Risk Factors=== | ||
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**[[Pulmonary edema]] | **[[Pulmonary edema]] | ||
**[[Hypoxia]] | **[[Hypoxia]] | ||
**[[ | **[[Altered mental status]] | ||
**[[Seizures]] | **[[Seizures]] | ||
**Sudden maternal cardiovascular collapse | **Sudden maternal cardiovascular collapse | ||
| Line 28: | Line 29: | ||
==Management== | ==Management== | ||
*Treat hypoxia | *Treat hypoxia (may require intubation) | ||
*Treat hypotension → [[Pressors]] / [[blood products]] | |||
*Treat hypotension | *Avoid hypoperfusion → Place patient in left lateral decubitus position | ||
*Immediate delivery of fetus → Emergent c-section | |||
*Avoid hypoperfusion | |||
*Immediate delivery of fetus | |||
**[[Perimortem C-section]] within 5min of cardiac arrest if mother cannot be resuscitated | **[[Perimortem C-section]] within 5min of cardiac arrest if mother cannot be resuscitated | ||
Revision as of 09:58, 9 December 2017
Background
- Maternal mortality rate ~80%
- 85% of survivors have neurologic sequelae
Risk Factors
- Cesarean delivery
- Advanced maternal age
- Abnormal placental implantation
- Uterine rupture
- Eclampsia
- Amniocentesis
- Trauma
Clinical Features
- 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
- Perimortem C-section within 5min of cardiac arrest if mother cannot be resuscitated
Disposition
- Admit