What is amniotic fluid embolism?

Amniotic fluid embolism is a rare and highly fatal obstetric emergency. Amniotic fluid embolism occurs in 7.7 per 100,000 births and the estimated mortality (death) rate is 70-90%. Amniotic fluid embolism can occur during pregnancy, but is more commonly found to occur during labor and shortly after. Rapid delivery and safe medical interventions are important in order to save the mother and baby’s life. Amniotic fluid embolism currently remains an unpredictable and unpreventable fatal complication of pregnancy.

What causes amniotic fluid embolism?

Amniotic fluid embolism is the result of an allergic-like reaction to amniotic fluid entering the mother’s circulatory system. Results of this reaction include:

• High blood pressure
• Blood clots in the lungs
• Failure of the right side of the heart
• Left ventricular failure
• Low blood pressure
• Shock
• Deprivation of oxygen
• Blue skin
• Coma
• Disseminated intravascular coagulopathy (DIC): This occurs when proteins which control blood clotting become overactive.

Amniotic fluid embolism is not preventable. Further research is being done to find possible ways to prevent it.

What are the risk factors for amniotic fluid embolism?

The risk factors for amniotic fluid embolism are undiagnosed and are currently being researched. Risk factors may help prevent and possibly provide earlier treatment. Possible risk factors, according to current research, include:

• Maternal age
• Multiple gestation (one or more fetuses)
• Fetal distress
• Placental abnormalities
• Eclampsia (seizures or convulsions)
• Polyhydramnios: This occurs when there is too much amniotic fluid surrounding the baby.
• Cervical lacerations
• Uterine rupture
• Induction medications or procedures
• Cesarean section
• Operative assisted deliveries (e.g., forceps or vacuum)
• Rapid and intense labor

What are the signs of amniotic fluid embolism?

Amniotic fluid embolism occurs in two phases:

• Phase one: Rapid respiratory failure and cardiac arrest. This phase has the highest fatalities.
• Phase two: This is the hemorrhagic phase. During this phase, the mother can experience excessive bleeding at the site of the Cesarean incision, or placental attachment.

Additional signs include:

• Acute low blood pressure or cardiac arrest
• Deprivation of oxygen
• Blood clotting or severe hemorrhage with no explanation. This can occur during labor, Cesarean birth, dilation, and evacuation within 30 minutes postpartum.

How is amniotic fluid embolism treated?

• Multiple blood, plasma and platelet transfusions
• Hysterectomy to stop the bleeding
• Steroids
• Urgent delivery
• Cardiopulmonary resuscitation
• Oxygenation by using tracheal tube or mechanical ventilation