![]() ![]() The cookie is used to store the user consent for the cookies in the category "Analytics". This cookie is set by GDPR Cookie Consent plugin. These cookies ensure basic functionalities and security features of the website, anonymously. Necessary cookies are absolutely essential for the website to function properly. Bloods - FBC, U&E, calcium and magnesium, clotting studies, ABG.It is therefore difficult to confirm the diagnosis and the focus should therefore revolve around resuscitation and stabilisation of the patient. The differential diagnosis will include other conditions that present in this way - such as pulmonary embolism, anaphylaxis, sepsis, eclampsia and myocardial infarction. Disseminated intravascular coagulation (this may be the first sign in some cases however nearly all patients will go on to develop this within 4 hours).It is characterised as an acute condition with the sudden onset of: As such, the manifestations of this complication of pregnancy resemble these disease processes. The physiology related to amniotic fluid embolism has been described as similar to anaphylaxis or severe sepsis. Fig 1 - Caesarean section is a risk factor for amniotic fluid embolism. However should cardiac arrest or severe maternal compromise occur, perimortem section is indicated to facilitate CPR of the mother.ĭefinitive diagnosis of amniotic fluid embolism is only definitively confirmed on post mortem and demonstrates fetal squamous cells along with debris in the pulmonary vasculature. ![]() If the baby is not yet delivered and the patient is relatively stable, continuous fetal monitoring should be instigated with a view to imminent delivery. All of this coordination should occur whilst rapid maternal resuscitation is administered.īasic ABCDE approach must not be forgotten, with high flow oxygen essential to minimise neurological compromise and fluids given as appropriate in order to counteract hypotension and haemodynamic instability.Īnaesthetics will be involved with measuring pulmonary artery wedge pressures and they will be able to take blood to assist with the diagnosis (shows fetal elements in the aspirate).ĭisseminated intravascular coagulation should be managed with the involvement of haematologists. If this condition is suspected, anaesthetics must be involved to arrange intensive care admission. Bloods – FBC, U&E, calcium and magnesium, clotting studies, ABGĮarly involvement of the multidisciplinary team is important.Investigations are similar to those undertaken during cardiac arrest and other emergency scenarios. All rights reserved.The mainstay of management in amniotic fluid embolism is resuscitation. In cases that require prolonged cardiopulmonary resuscitation or, after arrest, severe ventricular dysfunction refractory to medical management, consideration for venoarterial extracorporeal membrane oxygenation should be given.īlood product cardiac arrest coagulation cryoprecipitate dobutamine norepinephrine platelet right ventricular failure.Ĭopyright © 2019 Elsevier Inc. Amniotic fluid embolism-related coagulopathy should be managed with hemostatic resuscitation with the use of a 1:1:1 ratio of packed red cells, fresh frozen plasma, and platelets (with cryoprecipitate as needed to maintain a serum fibrinogen of >150-200 mg/dL). Blood pressure support with vasopressors is preferred over fluid infusion in the setting of severe right ventricular compromise. If such failure is identified, treatment that is tailored at improving right ventricular performance should be initiated with the use of inotropic agents and pulmonary vasodilators. Where available, we recommend performing transthoracic or transesophageal echocardiography as soon as possible because this is an easy and reliable method of identifying a failing right ventricle. We describe key features of initial treatment of patients with amniotic fluid embolism. Because amniotic fluid embolism usually is seen with cardiac arrest, the initial immediate response should be to provide high-quality cardiopulmonary resuscitation. ![]() Amniotic fluid embolism is an uncommon, but potentially lethal, complication of pregnancy. ![]()
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