eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Amniotic Fluid Embolism: Follow-up

Author: Lisa E Moore, MD, FACOG, Assistant Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of New Mexico Health Sciences Center
Contributor Information and Disclosures

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

References

  1. 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].

  2. 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].

  3. Benson MD, Kobayashi H, Silver RK, et al. Immunologic studies in presumed amniotic fluid embolism. Obstet Gynecol. Apr 2001;97(4):510-4. [Medline].

  4. 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].

  5. 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].

  6. Tuffnell DJ. United kingdom amniotic fluid embolism register. BJOG. Dec 2005;112(12):1625-9. [Medline].

  7. O'Shea A, Eappen S. Amniotic fluid embolism. Int Anesthesiol Clin. 2007;45(1):17-28. [Medline].

  8. 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].

  9. Aguilera LG, Fernandez C, Plaza A, et al. Fatal amniotic fluid embolism diagnosed histologically. Acta Anaesthesiol Scand. Mar 2002;46(3):334-7. [Medline].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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

Contributor Information and Disclosures

Author

Lisa E Moore, MD, FACOG, Assistant Professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of New Mexico Health Sciences Center
Lisa E Moore, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Medical Editor

John J Kavanagh Jr, MD, Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas College of Medicine
John J Kavanagh Jr, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Society of Gynecologist Oncologists, Southern Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital, Mammoth Lakes, California, Pioneer Valley Hospital, Salt Lake City, Utah, Warren General Hospital, Warren, Pennsylvania and Mountain West Hospital, Tooele, Utah
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Carl V Smith, MD, The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, University of Nebraska Medical Center
Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Arkansas Medical Society, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

 
 
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