Amniotic Fluid Embolism

Amniotic Fluid Embolism

Introduction to amniotic fluid embolism

Amniotic fluid embolism (abbreviated AFE) is a complication of pregnancy. It usually results in life-threatening conditions, for instance, heart failure. Amniotic fluid embolism may affect both mother and fetus. It occurs when the amniotic fluid seeps into the maternal blood. It also happens when fetal hair, cells or other debris make their way into the maternal blood.

Amniotic fluid embolism is not a common occurrence. This means that a clinical case occurs once-in-a-while. According to the AFE Foundation, amniotic fluid embolism occurs in only one in every 40,000 deliveries in North America. In Europe, it occurs in one in every 53,800 deliveries. However, AFE serves as a major cause of death during labor or shortly after birth. Countries where amniotic fluid embolism acts as a major cause of death include:

  • France
  • Australia
  • Poland
  • Japan
  • The United States
  • The United Kingdom

Amniotic fluid embolism
Photo Credit: NowBaby

What causes amniotic fluid embolism?

An amniotic fluid embolism can occur during labor. In some cases, it occurs shortly after giving birth (whether cesarean or vaginal birth). It rarely happens during an abortion or while extracting a small amount of the amniotic fluid for laboratory analysis (amniocentesis). It should be noted that amniotic fluid embolism is an adverse reaction that takes place when amniotic fluid seeps into the general circulation. There is nothing that can be done to prevent this condition. We do not fully understand why this reaction occurs.

What are the symptoms of amniotic fluid embolism?

The first symptom observed in AFE is a rapid respiratory failure and cardiac arrest. When a person stops breathing, he or she loses consciousness. Cardiac arrest occurs when a person’s heart stops working. Failure of the lungs to supply enough oxygen to the blood or extract carbon dioxide from is termed respiratory failure. Respiratory failure makes breathing difficult. Other symptoms that may manifest include:

  • Vomiting
  • Seizures
  • Fetal distress (symptoms that show that the baby is unwell, for instance a change in fetal heart rate or decreased movement in the uterus.
  • Nausea
  • Skin discoloration
  • Agitation, and severe anxiety

A second stage known as hemorrhagic phase awaits women who survive the first stage. In the second phase, there is excessive bleeding at the location where the placenta is attached, or at the point of cesarean incision (in the case of a cesarean birth).

Is amniotic fluid embolism a serious condition?

Yes! It may be fatal, especially in the first stage. Deaths attributed to AFE occur due to the flowing:

Studies by the AFE foundation shows that death usually happens within an hour after symptoms start in roughly 50 percent of cases.

Treatment for amniotic fluid embolism

Mother

Management of symptoms and prevention of progression to coma or death is key in the treatment of amniotic fluid embolism. Breathing can be enhanced by the use of a ventilator or via oxygen therapy. The amount of oxygen supplied is of great importance. This is because the oxygen available for the child is dependent on the amount taken by the mother. A pulmonary artery catheter may be inserted to assist the physicians to monitor your heart. Medications may be administered to help regulate blood pressure. In some cases, plasma, blood and platelet transfusions may be required to replace the blood lost during the second phase (hemorrhagic phase).

Infant

The baby will be well monitored for signs of distress. Delivery will take place as soon as the mother’s condition has stabilized. This raises the chances of survival. In many cases, babies may be admitted into the intensive care unit for close monitoring.

The outlook for amniotic fluid embolism

There are varied estimated rates of mortality for women suffering from amniotic fluid embolism. Estimates from older reports has it that at least 80 percent of sufferers do not survive, although recent data estimates this number is about 40 percent. Those who manage to survive do have long-term complications. These include:

  • Organ failure
  • Memory loss
  • Damage to the heart (which may be temporary or permanent)
  • Disorders with the nervous system
  • Partial or complete hysterectomy
  • Damage to the pituitary gland

There may also be emotional problems, especially if the baby dies. These may include postpartum depression and posttraumatic stress disorder.

Infant

Infants with AFE also have varied estimated rates of mortality. A study published in the Journal of Anesthesiology Clinical Pharmacology shows that around 30 percent of infants with amniotic fluid embolism do not survive. The AFE on its part reports that that infant mortality (for those still in the womb) can be as high as 65 percent. Infants that survive are plagued with long-term complications such as:

  • Mild or severe impairment of the nervous system
  • Poor oxygen supply to the brain
  • Cerebral palsy

Can amniotic fluid embolism be prevented?

Amniotic fluid embolism cannot be prevented. Physicians find it difficult to predict its occurrence. Mothers who have had an episode of this before should talk to a high-risk obstetrician before having another baby. The risks of pregnancy will be examined and you will be closely watched if you do get pregnant again.

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