The Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation proposed the following 4 criteria, all of which have to be met for the diagnosis of AFE to be made. The most common manifestations of AFE are cardiac arrest (40% in survivors and 90% in nonsurvivors), hemorrhage (70%), coagulopathy (60%), hypotension (50%-70%), arrhythmia (25%), dyspnea (30%-45%), seizures (15%), and fetal distress (35%). Several risk factors have been identified, including maternal factors (multiparity, advanced maternal age >35 years, gestational diabetes mellitus, eclampsia) and delivery-related factors (medical induction of labor, placenta abruption/previa, caesarian section, and instrumental vaginal delivery). The subsequent onset of disseminated consumptive coagulopathy is thought to be secondary to maternal exposure to prothrombotic substances and activators in fetal fluid and injured blood vessels, often exacerbated by the sequelae of a maternal arrest ( Table 15.1-1). The resultant ventricular failure leads to pulmonary edema and hypotension. If the mother survives this first insult, severe dilatation of the right ventricle causes relative left ventricular compression and elevated filling pressures with decreased left ventricular volume and stroke volume. Vasospasm of the pulmonary vasculature, hypoxia, and a rapid rise in right ventricular pressure leads to acute right heart failure and, in many cases, cardiac arrest. The acute onset of cardiovascular collapse is thought to result from an overwhelming activation of maternal inflammatory mediators in response to the fetal material. It is hypothesized that the disruption of the maternal-fetal barrier in labor allows for the passage of amniotic fluid, fetal cells, or other fetal debris into the maternal blood circulation, which in rare cases can trigger an anaphylactoid-type reaction. The exact pathogenesis of AFE remains unclear. Typically occurring during labor or shortly after delivery of the placenta, it is characterized by the sudden onset of cardiovascular and respiratory failure with no other identifiable cause followed by the rapid onset of disseminated intravascular coagulopathy ( DIC). PMID: 20956228.Īmniotic fluid embolism ( AFE) is a rare (1-2/100,000 deliveries) but frequently catastrophic obstetric emergency. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Jeejeebhoy FM, Zelop CM, Lipman S, et al American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. PMID: 31644848.Įxtracorporeal Life Support Organization. Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section. PMID: 31714909 PMCID: PMC6850527.īernstein SN, Cudemus-Deseda GA, Ortiz VE, Goodman A, Jassar AS. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, et al.
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