Amniotic Fluid Embolism

1 What is Amniotic Fluid Embolism?

Amniotic fluid embolism (AFE) is a potentially life-threatening complication of pregnancy in which the amniotic fluid or fetal material enters mother’s blood stream.

It is a rare condition, occurring in about one in 21,000 pregnancies. It occurs when the barrier between the amniotic fluid and maternal blood is infringed, allowing the entry of amniotic fluid or fetal material into the blood.

The actual cause of this condition is not known. It commonly occurs during delivery or shortly afterwards.

Immediate medical attention and rapid delivery is important to save mother’s life. About 60-80% of the patients do not survive embolism. 

2 Symptoms

Respiratory distress and cardiac failure are the two symptoms of Amniotic fluid embolism during the first phase. The symptoms develop suddenly and the condition progresses rapidly.

The common symptoms of the second phase of AFE are:

  • Sudden lowering of blood pressure
  • Blood clotting or severe hemorrhage
  • Increased heart rate
  • Fetal distress
  • Seizures
  • Severe anxiety
  • Coma
  • Excessive bleeding at the site of placental attachment or Cesarean section
  • Deprivation of oxygen
  • Pulmonary edema

3 Causes

The actual cause of Amniotic fluid embolism is not known.

The entry of amniotic fluid or fetal cells into mother’s blood stream affects on Amniotic fluid embolism. The actual cause for the entry of fetal material and fluid into the blood stream is not known.

Breach of the placental barrier is implied in the development of embolism. Breakdown of placental barrier triggers the immune system to release chemicals that cause inflammatory reaction.

This reaction affects the clotting of blood leading to a potentially serious condition known as disseminated intravascular coagulation.

Inflammatory reaction also leads to high or low blood pressure, shock, deprivation of oxygen, coma, failure of right side of the heart, and blood clotting abnormalities.

Some of the possible risk factors for AFE include

  • Age
  • Multiple gestation
  • Seizures
  • Fetal distress
  • Uterine rupture
  • Cervical bruises
  • Certain medical procedures and medications
  • Cesarean section
  • Forceps or vacuum deliveries
  • Rapid and intense deliveries
  • Increased quantity of amniotic fluid

4 Making a Diagnosis

Diagnosis of Amniotic fluid embolism is based on physical evaluation of symptoms. Respiratory distress and cardiovascular problems at the time of delivery or shortly after are two main indicators of AFE.

Other probable causes of the condition is ruled out before confirmatory diagnosis.

  • Blood tests help to assess clotting, enzymes, and electrolytes
  • Heart rhythm and cardiovascular distress is checked using ECG
  • Pulse oximetry is used to assess deprivation of oxygen 

It is very difficult to diagnose the condition as AFE starts suddenly and progresses rapidly.

In most of the cases, fetal material in the maternal blood stream is examined during autopsy.

5 Treatment

Emergency treatment to manage the symptoms of Amniotic fluid embolism and to prevent further damage is very important.

Treatment helps to control low blood pressure and low oxygen availability. If the symptoms start before delivery, arrangement is made for urgent delivery. This will reduce low oxygen damage to both mother and the baby.

In severe cases, intubation and pressure ventilation are suggested. Arterial catheters are used to monitor maternal blood pressure. Medications help to improve functioning of heart.

Transfusions of blood, platelets, and replacement fluids are required to compensate for the excessive bleeding. 

6 Prevention

There are no known prevention methods for Amniotic fluid embolism.

7 Alternative and Homeopathic Remedies

There are no known alternative and homeopathic remedies for curing Amniotic fluid embolism.

This condition is potentially life-threatening and requires immediate medical attention for continuous monitoring to save both mother’s and baby’s life.

8 Lifestyle and Coping

When diagnosed with Amniotic fluid embolism, it might be hard to cope and develop a normal lifestyle.

AFE may result in several complications for both mother and baby.

It is very challenging for the mother and immediate family.

Talk to the healthcare team, if you have any of the risk factors for AFE. 

9 Risk and Complications

Amniotic fluid embolism leads to serious complications for both mother and baby.

As oxygen availability becomes low, there is an increased chance of brain injury.

About 60-80% of women who have AFE do not survive.

Baby is also at an increased risk of death and brain injury.