Amniotic fluid embolism “ Anaphylactoid Syndrome of Pregnancy “

Prof. Dr. Bahaa EwissProfessor of Ansthesia & Intensive Care Unit

Ain Shams university

Introduction Amniotic fluid embolism is pure

unpreventable, unpredictable & incompletely

understood syndrome with potentially lethal

complication ( mortality rate up to 85%).

So since it is rapid , progressive & with lethal

complication, so the diagnosis is very difficult

& by exclusion.

It was 1st described by Brazilian medical journal in

1926 , then diagnosed in 1941 by finding fetal debris

in maternal lungs & Finally, in 1966, fetal debris were

found in maternal lungs, kidneys, spleen.

The pulmonary artery contains layers of pink

strips of squames,

derived from the amniotic

fluid.

Pathophysiology

Amniotic fluid + fetal debris

Amniotic fluid + fetal debris

Utero placental membrane leakage

Maternal circulation

Leukotriens&

PGs

Genesis of the syndrome

Predisposing factorsAge: > 35 years oldAmniocentesisArtificial rupture of

membraneCervical ulcerationC.S.EclampsiaFetal macrosomiaFetal distress

Medical induction of labor

InstrumentationMultiparicictyPlacenta previaPolyhydramniosUterine rupture

Presentation

In case of vaginal delivery or C.S. under

spinal anesthesia:

Acute unexplained hypotension

Desaturation , hypoxia , bronchospasm, ….

In case of C.S. under G.A. :

Unexplained hypotension, hypoxia ,

coagulopathy

Cardiac presentationBiphasic

Short & rapid Long & slow progressive

Right ventricular failure

Pulmonary hypertension

Pumonary edema

Hypoxia

Mortality 50 %

Left ventricular

failure

Hypotension

Pumonary congestion

Right ventricular

failure

Presentation cont….

Morbidity of the conditionDICHeart failureRenal failureNeurological ( convulsion)Post arrest complications

MonitoringBasic:

ECGNIBPSO2Capnography

Advanced:T.E.E.Invasive blood pressurePulmonary artery catheterCVP

Investigations “ non specific “

CBC : there is a marked decrease in the platelet levels

Fibrinogen: there is a decrease in the level

FDPs: there is an significant increase in the level

D.dimer : ????

ManagementDelivery may increase the survival of both the

baby & his mother

Management cont…..

According to CPR guideline of pregnant women

Oxygenation

E.T.T

Mechanical ventialtion

Cardio vascular

management

If the patient arrests

CPR must be started

(according to the international guidelines)

Adequate Oxygenation and early intubation

should be considered

Supportive therapy

Vasopressor

Nor adrenaline, dopamine , dobutamine

Management cont…..

Other line of management

Haemofiltration

Plasma exchange

ECMO

Cell salvage

Management of DIC

Ventilator assisted devices

Q1 :What about the role of heparin single dose??

Q2: What about corticosteroid IV??

Frequently asked questions

ConclusionAs it is rapid , progressive with lethal complications so we

should be minded about amniotic fluid embolism & rapid interference.

Good monitoring of the patient during labor , C.S. or in the recovery is mandatory.

Amniotic fluid embolism should be considered in case of rapid progressive hypotension, desaturation & hypoxia.

Rapid delivery of the baby.

CPR as soon as possible.