amniotic fluid embolism


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amniotic fluid embolism

Etymology: Gk, amnion; L, fluere, to flow; Gk, embolos, plug
a quantity of amniotic fluid that enters the maternal blood system during labor and/or delivery and becomes lodged in a vessel. It is usually fatal to the mother if it is a pulmonary embolism.

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 ?
McDonnell NJ, Chan BO, Frengley RW Rapid reversal of critical haemodynamic compromise with nitric oxide in a parturient with amniotic fluid embolism.
Farrar SC, Gherman RB 2001 Serum tryptase analysis in a woman with amniotic fluid embolism.
Acute hypotension associated with intraoperative cell salvage using a leukocyte depletion filter during management of obstetric hemorrhage due to amniotic fluid embolism.
While the hallmark presentation of amniotic fluid embolism (AFE) is this profound cardiopulmonary collapse with severe hemorrhage, it is important to note that published definitions of the condition state that coagulopathy may occur in isolation.
Survival rates were 46% for antepartum hemorrhage, 44% for myocardial infarction, 43% for amniotic fluid embolism, 38% for stroke, 29% for venous thromboembolism, 14% for trauma, and 0% for aneurysm or dissection.
Recognition of amniotic fluid embolism (AFE) is exceedingly rare.
Other major causes of pregnancy-related death included preeclampsia and eclampsia, amniotic fluid embolism, obstetric hemorrhage, and sepsis or infection.
Doctor's defense The patient had an unpredictable and untreatable amniotic fluid embolism.
Dozens of cases have been reported of women with massive postpartum hemorrhage who apparently had their life saved by rF-VIIa, (5-9) rF-VIIa has also been used successfully in severe hemorrhage following gynecologic surgery (10) and after amniotic fluid embolism with coagulopathy.
Potential risks associated with obstetric use include amniotic fluid embolism and maternal exposure to fetal red cells.
Nittaya Hendrickson died from an amniotic fluid embolism and her baby Chester had brain damage and also died.