amniotic fluid embolism


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amniotic fluid embolism

A condition resulting from a traumatic delivery and “injection” of amniotic fluid containing lanugo, squames, mucus and debris into the opened maternal circulation, which communicates with the amniotic fluid.
 
Aetiology
Idiopathic; predisposed to by the high intrauterine pressure that allows amniotic fluid to pass into the maternal venous circulation, where the meconium is toxic to the mother, potentially causing DIC.
 
Clinical findings
Acute shortness of breath, hypertension and rapid progression to cardiac arrest, leading to reduced cardiorespiratory perfusion and coma; those who survive this first phase pass to a haemorrhagic phase, which is characterised by shivering, coughing, vomiting and dysgeusia.

Incidence
1:80,000 deliveries.
 
Diagnosis
Made on clinical grounds, given the difficulty in identifying squames.

Mortality
26–80%.

IHC
LP34 is a better stain than Cam 5.2 or AE1/AE3, as the latter can stain alveolar epithelial cells.

amniotic fluid embolism

Obstetrics A condition resulting from a traumatic delivery and 'injection' of amniotic fluid containing lanugo, squames, mucus and debris into the opened maternal circulation, which communicates with the amniotic fluid Incidence 1:80,000 deliveries Etiology Idiopathic, predisposed to by the high intrauterine pressure that allows amniotic fluid to pass into the maternal venous circulation, where the meconium is toxic to the mother, potentially causing DIC Mortality ±80%. See Embolism.

amniotic fluid embolism

The entry of amniotic fluid through a tear in the placental membranes into the maternal circulation. This rare event may occur at any gestational age, but most commonly during labor, delivery or in the immediate postpartum period. The contents of the fluid (e.g., shed fetal cells, meconium, lanugo, vernix) may produce pulmonary or cerebral emboli. Cardiac arrest and disseminated intravascular coagulation (DIC) commonly occur. Maternal death is a frequent complication

Symptoms

Chest pain, dyspnea, cyanosis, tachycardia, hemorrhage, hypotension, or shock are potential symptoms. Amniotic fluid embolism is frequently fatal.

See also: embolism
References in periodicals archive ?
Phelan, "Hemodynamic alterations associated with amniotic fluid embolism: a reappraisal," American Journal of Obstetrics & Gynecology, vol.
Amniotic fluid embolism was thought to cause mechanical obstruction which leads to severe pulmonary hypertension, decreased (L) sided filling and consequently hypotension.
However, even as long ago as 2000 it was realised that if small quantities of amniotic fluid escaped the filter they would probably do no damage, because amniotic fluid embolism is no longer regarded as an embolic disease, but as a type of anaphylactic reaction (Clarke et al 1995, Fineschi et al 1998, Farrar & Gherman 2001).
Amniotic fluid embolism. Crit Care Clin 1991; 7:877-82.
Among the individual morbidities considered, increased risk was highest for renal failure, amniotic fluid embolism, cardiac morbidity, and shock, with adjusted odds ratios of 2.0 or greater for women older than 39 years.
Ob Hospitalist Group hosted the lunchtime lecture by Miranda Klassen on amniotic fluid embolism. Miranda, who founded the Amniotic Embolism Foundation (afesupport.org), is not only a survivor, she has made it her mission to educate physicians to identify and rapidly respond to this potentially fatal and often misdiagnosed condition.
Pete and Colin start their run in May and are raising money for Barnardo's and the Amniotic Fluid Embolism Foundation.
The 31-year-old picked up amniotic fluid embolism which affects around one in 80,000 pregnancies leaving her husband Matthew facing the grim prospect of losing both his wife and new-born daughter.
She'd suffered an amniotic fluid embolism - when the fluid from the womb enters the mother's bloodstream, causing an allergic reaction and bleeding.
Mr Cabrera was told immediately afterwards by doctors that she had died from an amniotic fluid embolism.
De Rooij et al reported a patient in the third trimester with amniotic fluid embolism. Caesarean section resulted in a "quick and uneventful recovery with complete resolution of the pulmonary oedema" but precise details of respiratory function were not provided (16).