Amniotic fluid embolus

Background
  • Maternal mortality rate ~80%
  • 85% of survivors have neurologic sequelae
  • Occurs in 2-8 per 100,000 deliveries[1]
    • Responsible for ~10% of maternal mortality in US

Risk Factors
  • Cesarean delivery
  • Advanced maternal age
  • Abnormal placental implantation
  • Uterine rupture
  • Eclampsia
  • Amniocentesis
  • Trauma

Clinical Features

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Evaluation
  • Diagnosis of exclusion

Management
  • Treat hypoxia (may require intubation)
  • Treat hypotension → Pressors / blood products
  • Avoid hypoperfusion → Place patient in left lateral decubitus position
  • Immediate delivery of fetus → Emergent c-section

A-OK Medications

Only case reports have described the following three therapies[2]

  1. Atropine - 1mg IV
    • Vagolytic properties may help
  2. Ondansetron 8 mg IV
    • Blocking of serotonin receptors can inhibits the release of more inflammatory mediators.
  3. Ketorolac - 30mg IV
    • Can block thromboxane production and prevent coagulopathies.

Disposition
  • Admit

See Also

References
  1. Fong A, Chau CT, Pan D, et al. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. 2014 Jun 30. 1-6.
  2. Rezai S. et al. Atypical Amniotic Fluid Embolism Managed with a NovelTherapeutic Regimen Case Reports in Obstetrics and Gynecology. 2017. https://www.researchgate.net/profile/Shadi_Rezai/publication/312332674_Atypical_Amniotic_Fluid_Embolism_AFE_Managed_With_A_Novel_Therapeutic_Regimen/links/5a3b50da458515a77aa99a21/Atypical-Amniotic-Fluid-Embolism-AFE-Managed-With-A-Novel-Therapeutic-Regimen.pdf
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