AMNIOTIC FLUID EMBOLISM
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Transcript of AMNIOTIC FLUID EMBOLISM
INCIDENCE
1:8000-1: 80 000
mortality is high
IN UK it is implicated in 10-12% of direct maternal deaths
PREDISPOSING FACTORS
1. older age
2. multiparicity
3. forceful labour
4. induction of labour
5. fetal macrosomia
6. placental abruption.
PATHOPHYSIOLOGY
forceful contractions
entry of amniotic fluid into the maternal circulation
pulmonary vascular obstruction
ventricular failure and cardiovascular collapse
PATHOPHYSIOLOGY
entry of a trigger
not yet identified into
the maternal bloodstream
causing release of inflammatory
mediators and collapse similar to
that seen in anaphylaxis and sepsis
FEATURES
1. sweating
2. shivering
3. convulsions
4. fetal bradycardia
5. dyspnoea
6. cyanosis
7. cardiovascular collapse
8. DIC
DIFFERENTIAL DIAGNOSIS
1. pulmonary (thrombo)embolism 2. air embolism 3. aspiration pneumonitis 4. Eclampsia5. local anaesthetic toxicity 6. stroke 7. left ventricular failure 8. sepsis 9. haemorrhagic shock 10.anaphylaxis
DIAGNOSIS
• The syndrome is a clinical diagnosis
• identifying fetal squamous cells in the pulmonary vasculature
• identification of fetal antigens in the
maternal circulation or lung tissue.
SUMMARY
• AFE unpredictable and lethal complication
of pregnancy
"anaphylactoid syndrome of pregnancy"