Amniotic Fluid Embolism Medication
- Author: Lisa E Moore, MD, FACOG; Chief Editor: Carl V Smith, MD more...
Medication Summary
Drugs are used in amniotic fluid embolism (AFE) to stabilize the patient. Pressors are used to maintain blood pressure, and inotropes are used to improve contractility. Use of steroids has been suggested because the process may be immune mediated. Uterotonics may be used to limit postpartum bleeding.
Sympathomimetic/vasopressor agents
Class Summary
Used in AFE to maintain blood pressure.
Dopamine (Intropin)
One of several drugs that can be used to maintain perfusion. Dopamine increases myocardial contractility and systolic BP with little increase in diastolic BP. Also dilates the renal vasculature, increasing renal blood flow and GFR.
Inotropes/inotropic agents
Class Summary
Used to improve myocardial contractility in patients with amniotic-fluid embolism.
Digoxin (Lanoxin, Lanoxicaps)
Cardiac glycoside that acts directly on the cardiac muscle and conduction system. Digoxin causes an increase in force and velocity of systolic contraction, a slowing of the heart rate, and decreased conduction velocity through the AV node.
Corticosteroids
Class Summary
Some authorities suggest steroid use may be helpful in AFE because the process may be immune mediated.
Hydrocortisone (Hydrocortone, Hydrocort, Cortef)
Because AFE is more similar to an anaphylactic reaction, steroids that mediate the immune responses are recommended.
Uterotonics
Class Summary
Cause the uterus to contract. Uterine atony (failure of the uterus to contract and involute, thus closing off the bleeding spiral arteries after delivery of the placenta) may be a source of significant postpartum bleeding.
Oxytocin (Pitocin, Syntocinon)
Most commonly used uterotonic. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Methylergonovine (Methergine)
Acts directly on uterine smooth muscle, causing a sustained tetanic uterotonic effect that reduces uterine bleeding.
Carboprost tromethamine (Hemabate)
Prostaglandin similar to F2-alpha (dinoprost), but has longer duration and produces myometrial contractions that induce hemostasis at placentation site, which reduces postpartum bleeding.
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