Amniotic Fluid Embolism: Risks, Interventions, and Prognosis for Current and Future Pregnancies
Amniotic Fluid Embolism (AFE) (also called anaphylactic syndrome of pregnancy) is a serious and often fatal complication that can occur in virtually any pregnancy, during or post termination, during vaginal labor and delivery, cesarean, or post-partum. In AFE, some amniotic fluid containing fetal cells enters into the maternal bloodstream, and the result is a immunologic reaction in the mother that can quickly become fatal for the mother, and often for the baby as well.
AFE occurs suddenly, without warning, progresses rapidly, and is a very rare event, which all contribute to catastrophic outcomes in most cases. Why and how AFE…show more content… In the first stage, the amniotic fluid with the fetal cells enter the maternal bloodstream, triggering an endogenous response, much like an anaphylactic reaction would. As it is understood, histamine, bradykinin, cytokines, prostaglandins, leukotrienes and thromboxane are all released in response and cause the signs and symptoms that manifest clinically. (7-1) Those clinical manifestations are pulmonary hypertension secondary to pulmonary artery vasospasm. The pulmonary hypertension increases the pressure in the right ventricle which results in hypoxia, as oxygen becomes limited. Hypoxia quickly damages the heart and pulmonary capillaries leading to left-sided heart failure and acute respiratory distress with pulmonary edema and hypotension. Hypotension can ultimately lead to renal failure, and the hypoxia is responsible for a high percentage of neurological impairments among survivors. According to one journal, 61% of surviving women, and 50% of surviving infants suffered persisting neurological impairment. (1-3) Approximately half of the women who die from AFE die during this stage, in the first hour after symptoms initially manifest. (7-1)
The second stage is marked by coagulopathies. Thromboplastin is found in amniotic fluid, and likely triggers the clotting cascade. Disseminated intravascular coagulation (DIC) and hemorrhage are common in the second stage, and DIC can occur within…show more content… A difficult obstacle in diagnosing is that there are many more common conditions that can have the same manifestations, and so recognizing the presence of AFE is arrived at through an exclusionary process rather than in other cases where a number of signs and symptoms can point rather directly at a condition. The exclusionary process results in wasted time in a situation of a rapidly developing chain of events that in most cases ends with mortality as diagnosis is difficult during the timeframe where action can be taken to interrupt the evolution of the condition and improve outcomes. For this reason, the high mortality rate is often the result of late diagnosis. In diagnosing, AFE is often misdiagnosed placental abruption, eclampsia, epilepsy, a cerebrovascular accident, a myocardial infarction, sepsis, an anesthesia reaction, or uterine rupture
