331: Differences in clinical presentation and outcomes between women with typical versus atypical amniotic fluid embolism

Obstetric emergencies often require intensive care intervention. Amniotic fluid embolism is a rare, unpredictable, and often catastrophic complication of pregnancy that is suspected in a woman who experiences cardiac arrest after a cesarean section. The condition occurs in approximately 1 in 40 000 births and has an average case-fatality rate of 16%. This complication may result from activation of an inflammatory response to fetal tissue in the maternal circulation. Risk factors may include maternal age over 35 years and conditions in which fluid can exchange between the maternal and fetal circulations. The presentation is abrupt, with profound cardiovascular and respiratory compromise, encephalopathy, fetal distress, and disseminated intravascular coagulopathy. Diagnosis is by exclusion and clinical presentation. Treatment is supportive, with a focus on reversal of hypoxia and hypotension, delivery of the fetus, and correction of coagulopathy. Staff debriefing and psychological support for the woman and family are vital.

Download Full-text

Tips on Amniotic Fluid Embolism

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v16i2.458 ◽

2021 ◽

Vol 16 (2) ◽

pp. 22-24

Author(s):

Kayvan Aflaki ◽

Sena Aflaki ◽

Joel Ray

Keyword(s):

Risk Factors ◽

Amniotic Fluid ◽

Clinical Setting ◽

Clinical Presentation ◽

Facteurs De Risque ◽

Sudden Onset ◽

Amniotic Fluid Embolism ◽

Prise En Charge ◽

Supportive Treatment ◽

Perinatal Morbidity

Amniotic fluid embolism (AFE) is a catastrophic, sudden-onset event that must be recognized immediately. Despite the rarity of this condition, both maternal and perinatal morbidity and mortality are significant with AFE, even in cases ideally managed. In this article, we present five key statements covering the risk factors, clinical presentation, and management of AFE in a clinical setting. The purpose of these tips is to provide clinicians with information that may improve their ability to make a timely diagnosis and establish appropriate supportive treatment to patients suffering from AFE. RésuméL’embolie amniotique est un événement catastrophique d’apparition soudaine qui doit être détecté immédiatement. Malgré la rareté de cette affection, la morbidité et la mortalité maternelles et périnatales sont importantes, même dans les cas où le traitement est idéal. Dans cet article, nous présentons cinq énoncés clés qui portent sur les facteurs de risque, le tableau clinique et la prise en charge de l’embolie amniotique dans un contexte clinique. Ces astuces visent à fournir aux cliniciens de l’information qui pourrait améliorer leur capacité à poser un diagnostic en temps opportun et à assurer un traitement de soutien approprié aux patientes atteintes d’une embolie amniotique.

Download Full-text

Peripartum Embolism

10.1093/med/9780190226459.003.0046 ◽

2017 ◽

Author(s):

Elizabeth M. S. Lange ◽

Paloma Toledo

Keyword(s):

Risk Factors ◽

Amniotic Fluid ◽

Maternal Morbidity ◽

Clinical Presentation ◽

Air Embolism ◽

Common Type ◽

Amniotic Fluid Embolism ◽

Maternal Risk ◽

Venous Air Embolism ◽

Maternal Morbidity And Mortality

Embolic disease during pregnancy is a significant contributor to maternal morbidity and mortality. The most common type of embolism is venous air embolism, but this is rarely symptomatic or hemodynamically significant. However, both thromboembolism and amniotic fluid embolism (AFE) are associated with significant maternal risk, and in the case of AFE, frequent major hemodynamic sequelae and fatal results ensue. As each class of embolic disease has slightly different risk factors, pathophysiology, clinical presentation, and treatment, they will each be discussed in separate sections in this chapter with an overview of these components.

Download Full-text

Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0391 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Tal Cahan ◽

Hila De Castro ◽

Anat Kalter ◽

Michal J. Simchen

Keyword(s):

Amniotic Fluid ◽

Diagnostic Criteria ◽

Clinical Presentation ◽

Mode Of Delivery ◽

Case Series ◽

Amniotic Fluid Embolism ◽

Published Data ◽

Vacuum Extraction ◽

Risk Pregnancy ◽

Diagnostic Criterion

Abstract Objectives An international diagnostic criterion for amniotic fluid embolism (AFE) diagnosis has recently been published. Data regarding subsequent pregnancies is scarce. We sought to implement recent diagnostic criteria and detail subsequent pregnancies in survivors. Methods A case series of all suspected AFE cases at a tertiary medical center between 2003 and 2018 is presented. Cases meeting the diagnostic criteria for AFE were included. Clinical presentation, treatment, and outcomes described. Pregnancy outcomes in subsequent pregnancies in AFE survivors detailed. Results Between 2003 and 2018 14 women were clinically suspected with AFE and 12 of them (85.71%) met the diagnostic criteria for AFE. Three cases occurred during midtrimester dilation and evacuation procedures, and the remaining occurred in the antepartum period. Of the antepartum cases, mode of delivery was cesarean delivery or vacuum extraction for expedited delivery due to presentation of AFE in 8/9 cases (88.88%). Clinical presentation included cardiovascular collapse, respiratory distress and disseminated intravascular coagulopathy (DIC). Heart failure of varying severity was diagnosed in 75% (9/12) cases. Composite maternal morbidity was 5/12 (41.66%), without cases of maternal mortality. 11 subsequent pregnancies occurred in four AFE survivors. Pregnant women were followed by a high-risk pregnancy specialist and multidisciplinary team if pregnancy continued beyond the early second trimester. Six pregnancies resulted in a term delivery. No recurrences of AFE were documented. Conclusions Use of a diagnostic criterion for diagnosis of AFE results in a more precise diagnosis of AFE. Nevertheless, the accuracy of clinical diagnosis is still high. Subsequent pregnancies were not associated with AFE recurrence.

Download Full-text