Amniotic fluid embolism

Definition:

• This is when fetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction which results in the signs and symptoms described below.

Epidemiology:

• Rare complication of pregnancy associated with a high mortality rate.Incidence 2/ 100,000 in the U.K .

Aetiology:

• Many risk factors have been associated with amniotic fluid embolism but a clear cause has not been proven. A consistent link has been demonstrated with maternal age and induction of labour. It is widely accepted that maternal circulation must be exposed to fetal cells/ amniotic fluid in order for an amniotic fluid embolism to occur. However the precise underlying pathology of this process which leads to the embolism is not well understood, though suggestions have been made about an immune mediated process.

Clinical presentation:

• The majority of cases occur in labour , though they can also occur during caesarean section and after delivery in the immediate postpartum.
• Symptoms include: chills, shivering, sweating, anxiety and coughing.
• Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.

Diagnosis:

• Clinical diagnosis of exclusion, as there are not definitive diagnostic tests.

Management:

• Critical care unit by a multidisciplinary team, management is predominantly supportive