Obstetric Emergency

(Amniotic Fluid Embolism)

“AFES”
This presentation is made by:
 Abdullah Essa Raham
 Hamza Basim Muhammad
 Ali Hussein Najim
 Definition
Amniotic Fluid Embolism is a complex
disorder during labor characterized by
amniotic fluid entering into the maternal
circulation which causes acute pulmonary
embolism, shock, DIC, acute renal failure or
abrupt death.
 Overview
 An devastating complication during labor
 Mortality: up to 60%~80%
 May occur in the first and second trimester
abortions
 Recently, it is also termed “anaphylactic
syndrome of pregnancy”
Risk Factors
Clinical Associations with AFES
Maternal risk factors
 Advanced maternal age
 Preeclampsia/eclampsia
 Trauma
 Diabetes mellitus

Neonatal risk factors

 Intrauterine fetal demise
 Fetal distress
 Fetal macrosomia
Complications of pregnancy
that have been linked to AFE
 Placenta previa
 Placental abruption
 Operative delivery
 Recent amniocentesis
 Meconium-stained
amniotic fluid
 Uterine overdistension
 Chorioamnionitis
 Induction of labor
 Rupture of amniotic
membranes
 Uterine rupture
 Cervical laceration
 Saline amnioinfusion
 Cell-salvaged blood
transfusion
Etiology :Three factors
 There is a breach in vein or blood sinus at the
trauma site of cervix and the body of uterine
 Higher pressure of amniotic cavity
 Disruption of fetal membrane

amniotic fluid enters into the maternal circulation

through the breached vein and blood sinus
 pathophysiology

Amniotic fluid→inferior vena → atrio dextro

→ right ventricle →pulmonary artery

 Pulmonary artery hypertension

 Anaphylactic shock
 DIC
 Acute renal failure(ARF)
Clinical features
 Major clinical findings ~
 Hypoxia & respiratory failure
 Due to Ventilation/Perfusion mismatching

 Some cases had bronchospasm

 Cardiogenic shock
 Disseminated intravascular coagulation
 Nonspecific symptoms: chills, nausea, vomiting,
agitation
 Some had tonic-clonic seizure
 Diagnosis
A. Collecting blood from pulmonary artery and inferior
vena cava, and finding components of amniotic
fluid
B. Clotting screen for DIC
C. ECG
D. X-ray
E. Autopsy
Principles of Management
 Aggressive monitor
 Early recognition of maternal & fetal hypoxia
 Pharmacologic therapy
 Fluid support
 Correct coagulopathy as needed
 in the case of sudden collapse, management should
be the structured ABC approach.
 The prognosis is poor, with approximately 30% of
patients dying in the first hour and only 10%
surviving overall.
 Management is supportive, requiring intensive care,
and there are no specific therapies available.
 Symptoms occurring just before the collapse may
be helpful in diagnosis.
 Perimortem caesarean section should be carried out
within 5 minutes or as soon as possible after cardiac
arrest. This is for the benefit of the woman to
improve the effect of resuscitation.
 Treatment
Obstetric management
antepartum intrapartum post partum

amnionic fluid embolism

drug treatment

Cervix is not open Cervix is fully

or not fully open dilated
Without postpartum
cesarean section delivery hemorrhage
Forcep delivery

Without hemorrage postpartum hemorrhage

Go on the expectant treatment hysterectomy Go on the expectant treatment

 Prevention
 Artificial rupture of membrane without stripping of membrane
 Don’t conduct artificial rupture of membrane when uterine is
constricting
 Master the indication of oxytocin application
 Protect the vessel during the caesarean section
 Avoid precipitate labor, birth trauma, rupture of uterus,
cervical laceration
 Aware of the predisposing factor
Referrences
1. Ten teachers; 20th edition
2. Embolism during pregnancy: thrombus,
air, and amniotic fluid; Anes. Clinics of
North America; Volume 21(1), March 2003
3. UpToDate ---- Amniotic Fluid Embolism