Amniotic fluid embolism

Amniotic Fluid Embolism: Causes, Symptoms, Treatment & Prevention

amniotic fluid embolism

It’s nice to meet you again today.  In this article, I will be discussing amniotic fluid embolism, its causes, signs and symptoms treatment and prevention. And I hope you would enjoy reading through.

Sometimes, a condition can occur when amniotic fluid is forced into the maternal circulation via uterus or placental site forming an embolism which obstructs pulmonary vessels leading to respiratory distress and circulatory collapse. The amniotic fluid may contain vernix, hair, foetal squamous cells or meconium and other debris.

What is amniotic fluid embolism (AFE)?

Amniotic fluid embolism (AFE) is rare  but  a serious condition that occurs when amniotic fluid –the fluid that surrounds the fetus in-utero during pregnancy or fetal materials such as fetal cells, hairs and other debris enter into the mother’s bloodstream via the uterus or placental site such that maternal collapse can progress  rapidly.

It is one of the direct causes of maternal mortality. However, the improvement in resuscitative measures has helped a lot in saving most maternal lives. Thus, AFI is no longer considered highly fatal as before. Remember, amniotic fluid embolism is also called liquor amnii embolism or simply AFE.

How common is Amniotic fluid embolism?

AFI is a very rare condition (about one in 800 deliveries). It is hard to predict and also difficult to prevent. The maternal mortality rate is as high as 86% and a foetal mortality rate is 50%.

When amniotic fluid embolism does occur?

AFE can occur at any pregnancy but mostly associated with labour and immediate post-delivery.

What are warning signs of AFE?

Amniotic fluid embolism is suspected in cases of sudden collapse and/or uncontrollable bleeding.

What are causes and risk factors of AFE?

Amniotic fluid embolism occurs when there is breaching of the barrier between the maternal circulation and amniotic sac during the periods of raised liquor amnii pressure such as termination of pregnancy (TOP) and other obstetric procedures. Its causes and risk factors include the following:

  • ·         Artificial rupture of membrane (ARM)
  • ·         Placental abruption — when the placental bed is disrupted
  • ·         Insertion of an intrauterine catheter during amniocentesis
  • ·         Intrauterine manipulations (e.g. internal podalic version or during a caesarean section)
  • ·         Rapid or precipitate labour
  • ·         Over-stimulation of uterus by uterotonics
  • ·         Multiparity and advanced maternal age
  • ·         Uterine trauma during manipulation

What are signs and symptoms of amniotic fluid embolism?

  • Sudden onset of maternal respiratory distress i.e. severe dyspnoea, cyanosis.
    • Chest pain
    • Coughing with frothy pink sputum
    • Profound hypotension and tachycardia
    • Shock out of proportion to blood loss
    • Vomiting, restlessness and anxiety
    • Convulsions immediately preceding collapse.

How to diagnose liquor amnii embolism

AFI is usually confirmed by detection of amniotic fluid in the blood or on post-mortem examination of the lungs.

How to manage AFE

Amniotic fluid embolism is an acute emergency. Thus, prompt care and resuscitation would save the maternal life and that of her baby. The tips will be of help:

  • Call for medical help
  • Assist in immediate resuscitation
  • Prepare for intubation and mechanical ventilation
  • Administer oxygen by face mask 8-10 litre/minute or by resuscitation bag delivery 100% oxygen
  • Arrange for intravenous infusion of fluid and aminophylline.
  • Put indwelling urinary catheter and measure hourly output
  • Prepare for emergency birth once maternal condition is stabilized.
  • Maintain proper record and report.

Midwives’ roles in managing amniotic fluid embolism

  • Initiate or help in resuscitation immediately after signs of respiratory distress occurs
  • Call for an ambulance or  medical aid while working in community
  • Monitor foetal and maternal condition
  • Prepare for emergency birth once the mother’s condition stabilizes.
  • Tilt the mother 30 degree to side to displace uterus.
  • Provide re-assurance and emotional support to the mother and family members. Keep them informed about what is happening.

What are effects of AFE on the fetus?

There is increased perinatal morbidity and mortality (fetal distress and intrauterine death/stillbirth) especially if amniotic fluid embolism occurs before the delivery of the baby. However, quick and prompt intervention to resuscitate the mother can reduce the fetal morbidity and mortality.

What are complications of liquor amnii embolism?

Poorly managed AFE is associated with the following:

  • Disseminated intravascular coagulation(DIC): This is far more likely to occur within 30 minutes of the initial maternal collapse
  • Suppression of myometrial action by amniotic fluid resulting in uterine atony and subsequently postpartum haemorrhage.
  • Acute renal failure related to blood loss and prolonged hypovolaemia
  • Maternal shock and death.

How to prevent amniotic fluid embolism

There are no specific ways of preventing amniotic fluid embolism. This is because it is hard to predict when it is likely to occur and also difficult to prevent.

However, it’s prudent that every midwife and obstetrician avoids any invasive and unnecessary procedures that would expose the mother and baby to liquor amnii embolism or that anything that would make the amniotic fluid or fetal membrane to enter into maternal bloodstream. 

Procedures such as external cephalic version, insertion of intrauterine catheter, rupture of membrane, incision of placenta during delivery and other maneuvers capable of causing trauma to the uterus should be avoided if possible.

Another way of preventing amniotic fluid embolism is by encouraging mothers to attend antenatal regularly, maintain adequate nutrition and utilize skilled and facility-based delivery, where equipment are available for emergency.  This would help save maternal life should amniotic fluid embolism occurs because there are enough resuscitative equipment to arrest the situation.

The bottom line

No mother deserves to die to pregnancy-related complications. Ensure you provide respectful and evidence-based maternity care always. Provide care to all mothers and children with least or no harm. Safety to all mothers and children! Thanks for reading and sharing to your friends.