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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 aborti
ons Recently, it is also termed “anaphylactoid syndro
me 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
Pulmonary artery hypertension Allergic shock DIC Acute renal failure(ARF)
Amniotic fluid→inferior vena → atrio dextro → right ventricle →pulmonary artery
Clinical presentation
Acute amniotic fluid embolism: occur acutely
Pulmonary artery
hypertension/ Shock
Hemorrhage due to DIC
Acute renal failure
Typical: three phages
Atypical: Bulk colporrhagia
shock(occur mainly after delivery)
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 fluidb. The basis of laboratory examination for DICc. ECGd. X-raye. Autopsy
Basis of laboratory examination for DIC
PLT < 100 10╳ 9/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
Anticonvulsive drug
OxygenationAminophylline
Narceine
Atropine
phentolamine
1 、 Disengage pulmonary hypertension, improve hypoxia:
2 、 Anti-anaphylacic
Glucocorticosteroid
Treatment
Hydrocortisone
Dexamethasone
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 vol
ume• Furosemide
Prevent infection• using antibiotic drug
with low toxicity
Treatment
antepartum intrapartum post partum
amnionic fluid embolism
drug treatment
Forcep delivery
postpartum hemorrhage
uterectomy
Without postpartum hemorrhage
Go on the expectant treatment
cesarean section delivery
Without hemorrage
Go on the expectant treatment
Treatment 6 、 Obstetric management
Cervical apertura is not open or not fully open
Cervical apertura is fully dilatting
Artificial rupture of membrane without stripping of membrane Don’t conduct artificial rupture of membrane when uterine is c
onstricting Master the indication of oxytocin application Protect the vessel during the caesarean section Avoid precipitate labor, birth trauma, rupture of uterus, cervic
al laceration Aware of the predisposing factor
Prevention