AMNIOTIC FLUID EMBOLISM Rare complication ~ 1: 8000 to 1: 30,000 pregnancies.

. Amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing cardiorespiratory collapse. Results in anaphylactic reaction and the syndrome may be described as anaphylactoid syndrome of pre nancy Usually a post mortem diagnosis presence of fetal s!uames in the maternal pulmonary circulation "o#e$er, fetal s!uamous and trophoblast cells are commonly found in the circulation of normal labouring #omen and other causes need to be e%cluded in an acutely ill labouring #oman &he first phase of the syndrome is characterised by p!lmonary "asospasm, hypo#ia and ac!te respiratory fail!re. 'omen #ho sur$i$e enter the haemorrhagic phase #ith ()* "o#e$er, coagulopathy #ith haemorrhage may be the initial presentation in 10 1+, of cases

Maternal ris$s

-ortality rate ~80 .0, +0, die #ithin 1h of onset of symptoms. /f those #ho sur$i$e the initial cardiorespiratory phase, +0, de$elop coagulopathy and there is a high ris0 of long term neurological impairment

Fetal ris$s

Acute fetal distress. 10, of fetuses sur$i$e.

%is$ factors

&raditionally thought to be multiparous #omen #ith a large baby e%periencing a short tumultuous labour associated #ith the use of uterine stimulants &here is no association with maternal age &olyhydramnios Uterine r!pt!re Use of o#ytocin Intra'!terine fetal death 2lacenta accreta Chorioamnionitis &ypically occurs d!rin la(o!r 3may occur during TO& ) a(dominal tra!ma4 -ore common #ith a male fet!s About 50, of patients ha$e a history of aller ies *an occur up to 58h after deli$ery However, the condition is unpredictable and unpreventable

Clinical feat!res

6udden onset profound hypotension (yspnoea 7 tachypnoea *yanosis *ardiac arrest 8itting may occur 8etal bradycardia "aemorrhage #ith uterine atony

Differential dia nosis

Anaphylactic reaction 2ulmonary embolism 2re eclampsia 9 eclampsia -yocardial infarction 6eptic shoc0 2lacental abruption Aspiration Aortic dissection

Mana ement

*all for assistance senior mid#ife 9 obstetrician 9 anaesthetist 9 )*U physician 9 porters Assess air#ay, breathing, circulation. Administer o%ygen to maintain normal saturation. )ntubate if necessary. Initiate CPR if the patient arrests. If no response to resuscitation, perform a perimortem C/S. :enous access ; blood for 8<*, crossmatch, U7=, >8&, clotting, FD& Disc!ss potential re!uirement of blood and blood products #ith haematologist &reat hypotension #ith crystalloid and blood products. Use "asoconstrictors if necessary *onsider p!lmonary artery catheteri*ation in patients #ho are hemodynamically unstable. Assess fetal #ellbeing ; deli$er if necessary &reat coagulopathy #ith FF&+ cryoprecipitate and platelets follo#ing discussion #ith haematologist &ransfer to ICU once deli$ered )dentify any neurological deficit and refer to ne!rolo ist