Amniotic fluid embolism

Amniotic fluid embolism is a rare and severe pregnancy complication. In this condition, the amniotic fluid that surrounds your fetus and fetal antigens enter maternal circulation. This results in hypoxia, hypotension, and coagulopathy.

The fetal antigens in the mother’s bloodstream trigger the inflammatory cascade and causes organ damage, especially heart and lungs. Amniotic fluid embolism usually occurs during delivery or immediately after the delivery.

In amniotic fluid embolism, there is an abrupt onset of symptoms which include the following:

  • Shortness of breath leading to respiratory distress
  • Accumulation fluid in the lungs
  • Cardiovascular collapse
  • Clotting problems
  • Chills and seizures
  • Fetal heart rate abnormalities
  • Severe bleeding from the uterus
  • Nausea and vomiting
  • Severe anxiety

Amniotic fluid embolism is considered to be unpredictable with unclear cause. However, it occurs when amniotic fluid and other fetal material enters the mother’s bloodstream. A breakdown in the placental barrier due to trauma may result in the leakage of amniotic fluid into the maternal circulation. As a result of trauma, the immune system responds by causing an inflammatory reaction. This reaction leads to the formation of abnormal clots in the lungs and heart of the mother.

Though there is no proper evidence, risk of developing amniotic fluid embolism is increased by the following factors:

  • Advanced maternal age
  • Multifetal pregnancy
  • Abdominal trauma
  • Cesarean delivery
  • Uterine rupture
  • Polyhydramnios
  • Induction of labor
  • Preeclampsia (hypertension and excess protein levels during pregnancy)

Amniotic fluid embolism is a life-threatening condition that may cause serious complications for you and your baby. The complications include:

  • Brain injury
  • Maternal death
  • Infant death

Your doctor may suspect amniotic fluid embolism if a classic triad occurs during the labor or after the delivery which includes sudden hypoxia, hypotension (decreased blood pressure), and coagulopathy (clotting abnormalities). Your doctor may recommend the following tests:

  • A chest X-ray - to determine pulmonary edema and acute respiratory distress syndrome.
  • Electrocardiogram - to evaluate the cardiovascular abnormalities
  • Echocardiography - to determine the heart’s function
  • Blood tests - to assess clotting abnormalities and heart enzymes
  • Pulse oximetry - to assess the oxygen levels in the blood

Amniotic fluid embolism requires an immediate treatment that involves supportive management. The initial emergency management includes the following:

  • Oxygen therapy or a ventilator helps with breathing.
  • An arterial catheter is placed to monitor the blood pressure.
  • A central venous catheter is positioned to give fluids, transfusions, and medications.
  • You may be given certain drugs to control blood pressure. In most of the cases, fluid replacement, plasma, and blood transfusions are given to replace the blood lost.
  • If bleeding cannot be controlled, performing hysterectomy would be life-saving.

Because of high maternal and fetal mortality rates, dealing with amniotic fluid embolism is a stressful event. Severe complications may be associated with the condition, and you may require a lengthy hospital stay. To cope up with the life-threatening pregnancy condition, discuss with your health care provider regarding the safe management of your recovery as well as, your baby’s recovery.

  

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