Amniotic fluid embolus: Difference between revisions

No edit summary
 
(25 intermediate revisions by 7 users not shown)
Line 1: Line 1:
==Pathophysiology==
==Background==
# release of amn fluid to maternal vessels during intense ut contractions or manipulation or at areas of placental separation.
*Maternal mortality rate ~80%
# most common during labor
*85% of survivors have neurologic sequelae
# leading cause of death during induced abortions
*Occurs in 2-8 per 100,000 deliveries<ref>Fong A, Chau CT, Pan D, et al. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. 2014 Jun 30. 1-6.</ref>
# can also be spontaneous or blunt trauma with abruption
**Responsible for ~10% of maternal mortality in US
# also post amniocentesis


==Diagnosis==
===Risk Factors===
# 2 or 3 trimester
*Cesarean delivery
# ut contraction or manipulation
*Advanced maternal age
# sudden hypotension, hypoxia, or coagulopathy
*Abnormal placental implantation
# triggers immunological response
*Uterine rupture
# death by vasospasm, release of vasoactive substances, mechanical plugging of mat pulm vasc tree
*[[Eclampsia]]
# get ARDS and L vent dysfnctn
*Amniocentesis
# fetal hair, squamous epithelial cells and debris in mat circulation
*Trauma


==Source==
==Clinical Features==
7/09 PANI
*Typically occurs during labor and delivery or 30 minutes after delivery
*Any of the following:
**[[Respiratory distress]]
**[[Pulmonary edema]]
**[[Hypoxia]]
**[[Altered mental status]]
**[[Seizures]]
**Sudden maternal [[shock|cardiovascular collapse]]
**[[DIC]]


[[Category:OB/GYN]]
==Differential Diagnosis==
{{Postpartum emergencies DDX}}
 
==Evaluation==
[[File:PMC3030025 kjae-59-S158-g001.png|thumb|Post cesarean [[chest X-ray]] in a patient with acute amniotic fluid embolus.]]
[[File:PMC2843707 1752-1947-4-55-2.png|thumb|[[Chest X-ray]] with diffuse infiltration throughout the lungs in a patient with acute amniotic fluid embolus.]]
[[File:PMC2843707 1752-1947-4-55-1.png|thumb|Chest CT showing homogeneous ground-glass opacities in a patient with acute amniotic fluid embolus.]]
*Diagnosis of exclusion
*Consider [[CXR]] and/or chest CT
 
==Management==
*Treat hypoxia (may require intubation)
*Treat hypotension → [[Pressors]] / [[blood products]]
*Avoid hypoperfusion → Place patient in left lateral decubitus position
*Immediate delivery of fetus → Emergent c-section
**[[Resuscitative hysterotomy]] within 5min of cardiac arrest if mother cannot be resuscitated
===A-OK Medications===
''Only case reports have described the following three therapies''<ref>Rezai S. et al. Atypical Amniotic Fluid Embolism Managed with a NovelTherapeutic Regimen Case Reports in Obstetrics and Gynecology. 2017. https://www.researchgate.net/profile/Shadi_Rezai/publication/312332674_Atypical_Amniotic_Fluid_Embolism_AFE_Managed_With_A_Novel_Therapeutic_Regimen/links/5a3b50da458515a77aa99a21/Atypical-Amniotic-Fluid-Embolism-AFE-Managed-With-A-Novel-Therapeutic-Regimen.pdf</ref>
#[[Atropine]] - 1mg IV
#*Vagolytic properties may help
#[[Ondansetron]] 8 mg IV
#*Blocking of serotonin receptors can  inhibits the release of more inflammatory mediators.
#[[Ketorolac]] - 30mg IV
#*Can block thromboxane production and prevent coagulopathies.
 
==Disposition==
*Admit
 
==See Also==
*[[Postpartum emergencies]]
 
==References==
<references/>
 
[[Category:OBGYN]]

Latest revision as of 12:43, 25 November 2021

Background

  • Maternal mortality rate ~80%
  • 85% of survivors have neurologic sequelae
  • Occurs in 2-8 per 100,000 deliveries[1]
    • Responsible for ~10% of maternal mortality in US

Risk Factors

  • Cesarean delivery
  • Advanced maternal age
  • Abnormal placental implantation
  • Uterine rupture
  • Eclampsia
  • Amniocentesis
  • Trauma

Clinical Features

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Evaluation

Post cesarean chest X-ray in a patient with acute amniotic fluid embolus.
Chest X-ray with diffuse infiltration throughout the lungs in a patient with acute amniotic fluid embolus.
Chest CT showing homogeneous ground-glass opacities in a patient with acute amniotic fluid embolus.
  • Diagnosis of exclusion
  • Consider CXR and/or chest CT

Management

  • Treat hypoxia (may require intubation)
  • Treat hypotension → Pressors / blood products
  • Avoid hypoperfusion → Place patient in left lateral decubitus position
  • Immediate delivery of fetus → Emergent c-section

A-OK Medications

Only case reports have described the following three therapies[2]

  1. Atropine - 1mg IV
    • Vagolytic properties may help
  2. Ondansetron 8 mg IV
    • Blocking of serotonin receptors can inhibits the release of more inflammatory mediators.
  3. Ketorolac - 30mg IV
    • Can block thromboxane production and prevent coagulopathies.

Disposition

  • Admit

See Also

References

  1. ↑ Fong A, Chau CT, Pan D, et al. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. 2014 Jun 30. 1-6.
  2. ↑ Rezai S. et al. Atypical Amniotic Fluid Embolism Managed with a NovelTherapeutic Regimen Case Reports in Obstetrics and Gynecology. 2017. https://www.researchgate.net/profile/Shadi_Rezai/publication/312332674_Atypical_Amniotic_Fluid_Embolism_AFE_Managed_With_A_Novel_Therapeutic_Regimen/links/5a3b50da458515a77aa99a21/Atypical-Amniotic-Fluid-Embolism-AFE-Managed-With-A-Novel-Therapeutic-Regimen.pdf
Retrieved from "https://www.wikem.org/w/index.php?title=Amniotic_fluid_embolus&oldid=329081"