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
6. Amniocentesis
7. Trauma

Evaluation

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 patient in left lateral decubitus position
4. Immediate delivery of fetus:
   1. Perimortem C-section within 5min of cardiac arrest if mother cannot be resuscitated

See Also

• Post-Partum Emergencies