Amniotic Fluid Embolism
Definition
Entering of amniotic fluid and fetal particulate materials into maternal blood circulation
Incidence
Rare : 1:8000 to 1:30,000 pregnancies
Cannot be predicted or prevented
Maternal mortality 13 - 86%. 50% deaths in the first hour
Often not diagnosed until autopsy
20 -40% neonatal mortality: half of survivors have neurological damage
80% of cases occur during lbour and 20% before or after birth
Aetiology
Unknown
Probably the amniotic fluid enters the maternal circulation due to torn placental membrane, torn uterine veins
May be associated with hypertonic uterus
Anaphylaxis; 40% have H/O atopy/allergy
Risk Factors
? Association between AFE and Oxytocin induction of labour and / or ARM
Multiparity
Advanced maternal age
Repeated Caesarian section >6
Placental abruption, fetal death
Clinical Features
Onset sudden and overhelming
Breathlessness, feeling doomed, chest pain, feeling cold, light headedness, paresthesia, panicking, restlessness, nausea, vomiting
Rapid progression from dyspnoea, hypotension to cardiac arrest
Seizures, coma
Hemorrhage
Fetal distress
Complications
DIC (Disseminated intravascular coagulation)
Cardiac arrest
Major neurological problems
Nursing Interventions
Call for emergency help
Start cardio-pulmonary resuscitation (CPR)
Administer O2
Treat shock with IV fluids
Arrange for emergency Caesarian section
Transfer to ICU
Support and care for the patient and her family
* * * * * * * * * * * * * * * *
