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Amniotic fluid embolism: a leading cause of maternal death yet still a medical conundrum

Amniotic fluid embolism is a rare and potentially catastrophic condition that is unique to pregnancy. The presentation may range from relatively subtle clinical events to sudden maternal cardiac arrest. Despite an increased awareness of the condition, it remains a leading cause of maternal mortality. The underlying mechanisms of amniotic fluid embolism are poorly understood, but current theories support an immune-based mechanism which is triggered by potentially small amounts of amniotic fluid gaining access to the maternal circulation.

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Featured

 Annie are you A-OK?

The proposed mechanism of the “A-OK” protocol in the setting of amniotic fluid embolism (AFE). Atropine (1 mg) blocks the vagal reflex and subsequent hypotension that occurs during AFE. It also reverses pulmonary artery spasm and vasoconstriction as well as bradycardia. Ondansetron (8 mg) blocks serotonin receptors, reversing pulmonary vasoconstriction and platelet activation. Ketorolac (30 mg) blocks thromboxane, halting the activation of the coagulation cascade and the release of inflammatory mediators.

Articles of Interest

Life in the Fastlane

... probably due to an anaphylactic reaction to fluid or fetal tissue.

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Amniotic Fluid Embolism: An Update of the Evidence

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Amniotic fluid embolism: lessons for rapid recognition and intervention

Amniotic fluid embolism is a rare, often fatal complication of labor and delivery. The classic presentation is the sudden onset of a triad of clinical manifestations: hypoxia, hypotension and coagulopathy. Understanding of the syndrome as an immunologically mediated, complicated and often catastrophic maternal response to fetal or placental antigens is coming into focus. New treatments such as extracorporeal membrane oxygenation (ECMO) and better use of old treatments such as transfusion offer hope, but the condition is often rapidly fatal, so saving the maternal and fetal lives depends on rapid recognition of the syndrome.

Incidence, risk factors, management and outcomes of amniotic-fluid embolism:

Amniotic fluid embolism (AFE) although rare, remains one of the leading causes of direct maternal mortality in high-income countries, characterised by unexplained sudden cardiovascular collapse, respiratory distress and disseminated intravascular coagulation.

Resources

Clinical Pain Advisor

Amniotic fluid embolism typically presents during labor, however, it has also been described elsewhere in peripartum or early postpartum period, as well as intraoperatively during cesarean deliveries without prior labor.

StatPearls

Amniotic fluid embolism (AFE) is a life-threatening obstetric emergency characterized by sudden cardiorespiratory collapse and disseminated intravascular coagulation. Amniotic fluid embolism (AFE) represents the second leading cause of peripartum maternal death in the United States and the number one cause of peripartum cardiac arrest.