P. 1
Amniotic Fluids Embolism

Amniotic Fluids Embolism

|Views: 7|Likes:
Published by lieynna4996

More info:

Categories:Types, Research
Published by: lieynna4996 on May 01, 2013
Copyright:Attribution Non-commercial


Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less






       1926, Ricardo Meyer 1941, Steiner & Luschbaugh autopsy series of 8 woman died of sudden shock during labor Other studies revealed amniotic fluid debris in maternal kidney, liver, spleen, pancreas, brain Amniotic fluid embolism (AFES), or anaphylactoid syndrome of pregnancy Incidence: 1/8000 ~ 1/80000 Maternal mortality: 60 ~ 90 % AFES & Pulmonary thromboembolism  20% perinatal maternal mortality

 Entrance of amniotic fluid to maternal circulation: o Endocervical veins o Placental insertion site o Site of uterine trauma Why Anaphylactoid Syndrome of Pregnancy? 1. A lag period 2. Amniotic debris in non-AFES mother 3. Variability of clinical s/s and its severity Proposed Mechanisms~ 1. Host immune responses 2. Abnormal amniotic fluid, atypical substance

Clinical Presentation
 Onset most commonly during labor & delivery Clinical Presentation of a Review  272 cases ~ o Nonspecific symptoms: chills, nausea, vomiting, agitation o Cardiorespiratory collapse occurred at presentation in the majority o Some had tonic-clonic seizure Major clinical findings ~ o Hypoxia & respiratory failure o Cardiogenic shock o Disseminated intravascular coagulation Each of the above can be the dominant presentation

hypoxia  When AFES occurs postpartum and DIC is the major early finding. Aspiration of gastric contents 7. High protein concentration in lung edema fluid 2. squamous and trophoblastic cells. lanugo) from the distal port of a pulmonary artery catheter to make the diagnosis o But. Hemorrhage 2. mucin. Air or pulmonary embolism 3. diagnosis may be delayed due to s/s mimics hemorrhage! Diagnosis   Via symptoms & signs  suspicion of AFES Other causes of sudden cardiorespiratory failure ~ 1. Symptoms/Signs similar to anaphylactoid or septic shock  Risk factors unknown?  Etiology unkown? Major clinical findings ~  Hypoxia & respiratory failure  Cardiogenic shock  Disseminated intravascular coagulation Hypoxemia  Due to Ventilation/Perfusion mismatching  Some (15%) cases had bronchospasm st  50% 1 hour death were due to hypoxia and cardiogenic shock  May result in neurologic impairment  70% who initially survived developed pulmonary edema  May be cardiogenic or noncardiogenic  Evidence for endothelial-alveolar membrane damage  capillary leak  1. PEA. Anaphylaxis 5. Amniotic fluid debris in sputum & alveoli Major clinical findings ~  Hypoxia & respiratory failure  Cardiogenic shock  Disseminated intravascular coagulation Cardiovascular Collapse  Pulmonary artery & pulmonary capillary wedge pressures ↗  Cardiac output ↘  LV stroke index↘  PA catheter data usually show CO↓ with relatively small increase in pulmonary vascular resistance  Arrhythmia. Myocardial infarction Some authors require the amniotic fluid debris (eg. Sepsis 6. asystole may occur Major clinical findings ~  Hypoxia & respiratory failure  Cardiogenic shock  Disseminated intravascular coagulation DIC  80% AFES develop DIC  The temporal correlation is not constant among DIC. Anesthetic complications 4. cardiogenic shock. amniotic fluid components commonly are present in the maternal circulation in women with no s/s of AFES  .

Monitoring  SpO2  EKG  Arterial line  Fetal monitor if onset prior to delivery  Echocardiography  CVP alone is not sufficient  Pulmonary artery catheterization Management ---.Maternal Hypoxia  Secure airway  Intubation & Ventilation o Small tidal volume (6 ~ 8 ml/kg) o Normocapnia (~32 mmHg)  PEEP Management ---. if possible o Avoid exacerbating pulmonary edema o Initial management with vasopressor is preferred  Correct coagulopathy with blood product as needed .Management  Aggressive monitor  About maternal & fetal hypoxia  Pharmacologic therapy  Fluid support  Correct coagulopathy as needed Management ---.Fetal Hypoxia  65% fatal AFES present before delivery  Prevention of Fetal Hypoxia o Maternal PO2 keep > 47 mmHg. best above 65 mmHg o Fetal umbilical vein PO2 >32 mmHg  Fetal compensation by elevated Hb level & cardiac output o Immediate delivery decreases fetal morbidity Pharmacologic Therapy  Inotropic & vasoactive agents o Norepinephrine o Dopamine o Dobutamine (often use norepinephrine in combination) Fluid management  Pulmonary artery catheter insertion first.

You're Reading a Free Preview

/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->