Download Amniotic Fluid Embolism

Amniotic Fluid Embolism
Women’s 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 fluid→inferior 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
antepartum
intrapartum
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
Don’t 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