Amniotic Fluid Embolism: Know All About The Rare & Dangerous Childbirth Problem

What is Amniotic Fluid Embolism (AFE)?

AFE is one of the most challenging and rare childbirth emergencies. In AFE, the amniotic fluid enters the bloodstream of the mother and triggers a serious reaction that results in cardiorespiratory collapse or massive bleeding.

Prevalence:

AFE occurs in about 2–8 of 100,000 pregnancies and is reported to be responsible for about 7.5-10% of all maternal deaths in the United States.

What are the Signs & Symptoms of AFE?

• Rapid deterioration of the maternal condition
• Cardiac arrest
• Arrhythmia
• Hypotension
• Respiratory distress
• Coagulopathy
• Massive hemorrhage
• Acute fetal compromise
• Tingling
• Shortness of breath
• Agitation
• Cardiovascular collapse

What are the risk factors of AFE:

Prenatal risk factors of AFE include gestational diabetes, advanced maternal age, polyhydramnios, multiple pregnancies, placental abruption, and placenta previa. Additionally, several other risk factors related to common obstetric interventions such as induction of labor, operative vaginal delivery, and cesarean delivery are also included.

How is AFE diagnosed?

Via blood tests, ECG/EKG, pulse oximetry, chest x-ray, echocardiography, your health care provider will be able to diagnose the condition.

Treatment options:

AFE requires rapid treatment to address low blood pressure and oxygen levels. Here’s a list of emergency treatments:

• Oxygen supply via a breathing tube inserted into patients' airway to help them breathe.
• Catheter placement- using a thin, hollow tube that is placed into the patient’s arteries could help monitor the blood pressure. Chest catheters are also used to administer medications, fluids or transfusions.
• Blood transfusions in case of uncontrollable bleeding. Other blood products and replacement fluids might also need to be transcribed.
• Medications to improve and support the patient’s heart function and lowering blood pressure might need to be administered.

If AFE is diagnosed before delivery, doctors usually treat the mother with the goal of safely delivering the child at the earliest. Sometimes, emergency C-sections might be needed.

Few important facts about AFE:

• Given the acuity and complexity of the condition, immediate response by a multidisciplinary team of doctors specialized in the fields of obstetrics, maternal-fetal medicine, intensive care, anesthesia, and hematology is important.
• Sometimes, myocardial infarction and other conditions like consumptive coagulopathy and cardiorespiratory symptoms are recognized as AFE. It is important to exclude other possible diagnoses, especially those that are caused by excessive bleeding.
• Knowledge of the risk factors of AFE is of little use for clinical prediction of the condition since a vast majority of women with such risk factors usually have a normal pregnancy as well as delivery.