1st Slide / Introduction
- Sudden low blood pressure
Let’s talk about Amniotic fluid embolism. First,
what is Amniotic fluid? Ang amniotic fluid ito yung
tinatawag na panubigan. So ano ba ang trabaho ng
panubigan or amniotic fluid? This is the one who
protects the baby from injury and bumps inside the
mother’s tummy. Dun sya nag si swim, yun din
yung iniinom at iniiihi nya. So kapag konti ang
tubig ni baby ang tawag dun is Oligohydramnios,
pag madami naman polyhydramnios. So dapat sa
ultrasound ng isang mother ang nakalagay is
adequate amniotic fluid yun yung normal.
Let’s proceed to amniotic fluid embolism, An AFE
appears to result from an abnormal maternal
response to amniotic fluid entering the mother’s
bloodstream during labor and birth. It is a rare but a
life-threatening complication that affects pregnant
women. It occurs when amniotic fluid or other fetal
material enters the mother’s bloodstream. This may
be cause from small tears on the lower part of the
uterus or because of the damage or abnormality
affecting the placenta.
2nd Slide
So, when this happens, abnormal clotting happens
to the mother’s lungs and blood vessels as response
to the immune system and this is the disorder called
disseminated intravascular coagulation which most
women with AFE develop. However, this disorder is
rare, because some mother’s amniotic fluid enters
their bloodstream without causing this problem.
That is why the pathophysiology of AFE is still not
completely understood.
3rd Slide / Epidemiology
Incidence of AFE is estimated to occur between 1 in
8000 and 1 in 80,000 deliveries. Previous studies
revealed mortality rates as high as 61-86%, but
recent estimates suggest a case fatality of 13-26%.
This decrease in risk for maternal mortality from
AFE may be the result of early diagnosis and better
resuscitative care as well as changes in case
inclusion criteria.
4th Slide / Sign and symptoms
- Sudden shortness of breath or dyspnea
- Excess fluid in the lungs (pulmonary edema)
- Sudden failure of the heart to effectively pump
blood (cardiovascular collapse)
- Life-threatening problems with blood clotting
(disseminated intravascular coagulopathy)
- Bleeding from the uterus, caesarean incision or
intravenous (IV) sites
- Altered mental status, such as anxiety or sense
of doom
- Chills
- Rapid heart rate or disturbances in the rhythm of
the heart rate
- Fetal distress, such as slow heart rate, or other
fetal heart rate abnormalities
- Seizures
- Loss of consciousness
5th / Complication
AFE can cause serious complication for the mother
and the baby which includes
- brain injury
- lengthy hospital stays due to long treatment in
ICU
- maternal death
- infant death
6th Slide / 4 Criteria In Diagnosing AFE
so, there is 4 criteria in diagnosing AFE
- Acute hypotension or cardiac arrest
- Acute hypoxia
- Coagulopathy or severe hemorrhage in the
absence of other explanation
- All of these occurring during labor, caesarean
delivery, dilation and evacuation, or within 30
mins postpartum with no other explanation of
findings
7th Slide
AFE is a medical emergency and requires rapid
treatment to address the low blood oxygen and low
blood pressure so this treatment includes catheter
placement specifically an arterial catheter to
monitor blood pressure and a central venous
catheter to gives fluid medication or transfusions as
well as draw blood.

8th Slide / Medical Management

- Oxygenation - We have to give oxygen to have
the mother breath normally
- Digitalis/Digoxin - Medication to improve and
support the heart, as well as decrease the
pressure cause by the fluid going to the heart
and lungs. Digoxin or digitalis it increases
contractions of the heart. Bakit pina pa contract
yung heart? Para mag circulate yung blood.
- Heparin with standby Protamine Sulphate - so
heparin is anticoagulant drug with standby
protamine sulphate – para magtuloy tuloy yung
circulation ng blood.
- IV fluids and Blood transfusion to improve
hydration and replacement fluids in case or to
control bleeding
- Monitor I &O
9th Slide / Key Factors
If AFE is diagnosed before the delivery of the baby,
the doctors will prioritize the delivery of the baby
and possible Cesarean section delivery is needed.
So, the key factors in the management of AFE are
- early recognition
- prompt resuscitation
- delivery of the fetus
early recognition is critical to a successful outcome,
management is primarily supportive and
resuscitative.