Amniotic fluid embolus

Background

• Diagnosis of exclusion
• Maternal mortality rate ~80%; 85% of survivors have neurologic sequelae

Risk Factors

1. Cesarean delivery
2. Advanced maternal age
3. Abnormal placental implantation
4. Uterine rupture
5. Eclampsia

Diagnosis

1. Any of the following:
   1. Respiratory distress
   2. Pulmonary edema
   3. Hypoxia
   4. AMS
   5. Seizures
   6. Sudden maternal cardiovascular collapse
   7. DIC

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

• Acute fatty liver of pregnancy
• Amniotic fluid embolus
• Chorioamnionitis
• Eclampsia
• HELLP syndrome
• Mastitis
• Peripartum cardiomyopathy
• Postpartum endometritis (postpartum PID)
• Postpartum headache
• Postpartum hemorrhage
• Preeclampsia
• Resuscitative hysterotomy
• Retained products of conception
• Septic abortion
• Uterine rupture

Management

1. Treat hypoxia
   1. NRB or intubate
2. Treat hypotension
   1. Pressors / blood products
3. Avoid hypoperfusion
   1. Place pt in left lateral decubitus position
4. Immediate delivery of fetus:
   1. Perimortem C-section w/in 5min of cardiac arrest if mother cannot be resuscitated

See Also

• Post-Partum Emergencies

Source

Tintinalli