Amniotic Fluid Embolism

Womens Hospital School of Medicine Zhejiang

University
Wang Zhengping

Definition
Amniotic Fluid Embolism is a complex disorder
during labor characterized by amniotic fluid
entering into the maternal circulation which
causes acute pulmonary embolism, shock,
DIC, acute renal failure or abrupt death.

overview

An devastating complication during labor

Mortality: up to 60%~80%
May occur in the first and second trimester
abortions
Recently, it is also termed anaphylactoid
syndrome of pregnancy

Why amniotic fluid can enter into the

maternal circulation?

Etiology :Three factors

There is a breach in vein or blood sinus at the

trauma site of cervix and the body of uterine
Higher pressure of amniotic cavity
Disruption of fetal membrane

amniotic fluid enters into the maternal circulation

through the breached vein and blood sinus

What would happen

after the amniotic fluid enter into
the maternal circulation

pathophysiology
Amniotic fluidinferior vena atrio dextro
right ventricle pulmonary artery

Pulmonary artery hypertension

Allergic shock
DIC
Acute renal failure(ARF)

Clinical presentation
Acute amniotic fluid embolism: occur acutely
Pulmonary artery
Typical: three phages

hypertension/ Shock
Hemorrhage due to DIC

Atypical:

Acute renal failure

Bulk colporrhagia
(occur mainly after delivery)
shock

Diagnosis

According to the typical clinic manifestation, we can

make the preliminary diagnosis and save the
patients immediately
While saving the patients do the necessary auxiliary
examination, including:
a. Collecting blood from arteria pulmonalis and inferior
vena, and finding components of amniotic fluid
b. The basis of laboratory examination for DIC
c. ECG
d. X-ray
e. Autopsy

Basis of laboratory examination for DIC

PLT 100 109/L or it was gradually decrease

fibrinogen <1.5g/L
PT >15 s
plasm protamine paracoagulation test (+)
Obtrite RBC in blood smear

Management

Improve hypoxia
Anti-anaphylacic shock
Prevent DIC and acute renal failure(ARF)
Prevent infection

Treatment
1 Disengage pulmonary hypertension,
improve hypoxia:
Oxygenation
Anticonvulsive drug

Aminophylline
Narceine
Atropine
phentolamine

Treatment
2 Anti-anaphylacic
Hydrocortisone

Glucocorticosteroid

Dexamethasone

Treatment
3 Anti-shock
Transfusion
Angiotensin
Treat heart failure
Cure acidemia

Treatment
4 Prevent and cure
DIC

Use decoagulant and heparin as early as

possible

Treatment
5 Prevent or cure ARF and infection

Prevent ARF:
aware of urinary
volume
Furosemide

Prevent infection
using antibiotic drug
with low toxicity

Treatment
6 Obstetric management
intrapartum
antepartum

post partum

amnionic fluid embolism

drug treatment
Cervical apertura is not open
or not fully open

cesarean section delivery

Without hemorrage
Go on the expectant treatment

Cervical apertura
is fully dilatting

Forcep delivery

Without postpartum
hemorrhage

postpartum hemorrhage
uterectomy

Go on the expectant treatment

Prevention

Artificial rupture of membrane without stripping of membrane

Dont conduct artificial rupture of membrane when uterine is
constricting
Master the indication of oxytocin application
Protect the vessel during the caesarean section
Avoid precipitate labor, birth trauma, rupture of uterus,
cervical laceration
Aware of the predisposing factor