eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications
Amniotic Fluid Embolism: Follow-up
Updated: Aug 12, 2008
Follow-up
Further Inpatient Care
Admit the patient with amniotic fluid embolism (AFE) into the ICU.
Transfer
Transfer to a level 3 hospital may be required once the patient is stable.
Deterrence/Prevention
AFE is an unpredictable event.
Complications
- Pulmonary edema is a common occurrence in survivors. Pay close attention to fluid input and output.
- Left heart failure may occur. Some sources recommend inotropic support.
- Treat DIC with blood components. Consider activated factor VIIa for severe hemorrhage. Bilateral uterine artery embolization has been successful in controlling blood loss in 2 reported cases.
Prognosis
- Maternal mortality is 61%.
- Most survivors have neurologic deficits.
- The intact infant survival rate is 70%. Neurologic status of the infant is directly related to the time elapsed between maternal arrest and delivery.
- Risk of recurrence is unknown. Successful subsequent pregnancies have been reported. The recommendation for elective cesarean delivery during future pregnancies in an attempt to avoid labor is controversial.
Miscellaneous
Medicolegal Pitfalls
- Failure to respond emergently is a pitfall. AFE is a clinical diagnosis. Steps must be taken to stabilize the patient as soon as symptoms manifest.
- Failure to perform perimortem cesarean delivery in a timely fashion is a pitfall. After 5 minutes of unsuccessful CPR, abdominal delivery is recommended.
- Failure to consider the diagnosis during legal abortion is a pitfall. A review of the literature indicates that most case reports of AFE have occurred during late second-trimester abortions.
More on Amniotic Fluid Embolism |
| Overview: Amniotic Fluid Embolism |
| Differential Diagnoses & Workup: Amniotic Fluid Embolism |
| Treatment & Medication: Amniotic Fluid Embolism |
Follow-up: Amniotic Fluid Embolism |
| References |
| Further Reading |
| « Previous Page |
References
Clark SL, Hankins GD, Dudley DA, et al. Amniotic fluid embolism: analysis of the national registry. Am J Obstet Gynecol. Apr 1995;172(4 Pt 1):1158-67; discussion 1167-9. [Medline].
Clark SL, Pavlova Z, Greenspoon J, et al. Squamous cells in the maternal pulmonary circulation. Am J Obstet Gynecol. Jan 1986;154(1):104-6. [Medline].
Benson MD, Kobayashi H, Silver RK, et al. Immunologic studies in presumed amniotic fluid embolism. Obstet Gynecol. Apr 2001;97(4):510-4. [Medline].
Farrar SC, Gherman RB. Serum tryptase analysis in a woman with amniotic fluid embolism. A case report. J Reprod Med. Oct 2001;46(10):926-8. [Medline].
Marcus BJ, Collins KA, Harley RA. Ancillary studies in amniotic fluid embolism: a case report and review of the literature. Am J Forensic Med Pathol. Mar 2005;26(1):92-5. [Medline].
Tuffnell DJ. United kingdom amniotic fluid embolism register. BJOG. Dec 2005;112(12):1625-9. [Medline].
O'Shea A, Eappen S. Amniotic fluid embolism. Int Anesthesiol Clin. 2007;45(1):17-28. [Medline].
Kramer MS, Rouleau J, Baskett TF, Joseph KS,. Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet. Oct 21 2006;368(9545):1444-8. [Medline].
Aguilera LG, Fernandez C, Plaza A, et al. Fatal amniotic fluid embolism diagnosed histologically. Acta Anaesthesiol Scand. Mar 2002;46(3):334-7. [Medline].
Hankins GD, Snyder R, Dinh T, et al. Documentation of amniotic fluid embolism via lung histopathology. Fact or fiction?. J Reprod Med. Dec 2002;47(12):1021-4. [Medline].
Kobayashi H, Ohi H, Terao T. A simple, noninvasive, sensitive method for diagnosis of amniotic fluid embolism by monoclonal antibody TKH-2 that recognizes NeuAc alpha 2-6GalNAc. Am J Obstet Gynecol. Mar 1993;168(3 Pt 1):848-53. [Medline].
Lim Y, Loo CC, Chia V, Fun W. Recombinant factor VIIa after amniotic fluid embolism and disseminated intravascular coagulopathy. Int J Gynaecol Obstet. Nov 2004;87(2):178-9. [Medline].
Kaneko Y, Ogihara T, Tajima H, Mochimaru F. Continuous hemodiafiltration for disseminated intravascular coagulation and shock due to amniotic fluid embolism: report of a dramatic response. Intern Med. Sep 2001;40(9):945-7. [Medline].
Hsieh YY, Chang CC, Li PC, Tsai HD, Tsai CH. Successful application of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation as lifesaving therapy for a patient with amniotic fluid embolism. Am J Obstet Gynecol. Aug 2000;183(2):496-7. [Medline].
Goldszmidt E, Davies S. Two cases of hemorrhage secondary to amniotic fluid embolus managed with uterine artery embolization. Can J Anaesth. Nov 2003;50(9):917-21. [Medline].
Further Reading
In 1993, Benson suggested a broader clinical definition of amniotic fluid embolism (AFE). Type 1 AFE was associated with DIC and type 2 AFE was not associated with DIC. The onset of symptoms as late as 48 hours postpartum were included in the definition. These criteria were not used in the AFE registries and have not been widely accepted. The article nonetheless provides interesting reading about possible nonfatal AFE.
Benson MD. Nonfatal amniotic fluid embolism. Three possible cases and a new clinical definition.
Arch Fam Med. 1993 Sep;2(9):989-94. [ Medline ]
Keywords
amniotic fluid embolism, anaphylactoid syndrome of pregnancy, obstetric emergency, fetal debris in pulmonary circulation, amniotic fluid embolization, AFE, fetal squamous cells. anaphylactic reaction to fetal antigens, hypoxia, myocardial capillary damage, pulmonary capillary damage, left heart failure, acute respiratory distress syndrome, disseminated intravascular coagulation, DIC
Follow-up: Amniotic Fluid Embolism