Amniotic Fluid Embolism Treatment & Management

Updated: Jun 07, 2017
  • Author: Lisa E Moore, MD, FACOG; Chief Editor: Carl V Smith, MD  more...
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Treatment

Medical Care

Admit the patient with amniotic fluid embolism (AFE) into the intensive care unit (ICU).

Treatment is supportive and includes the following:

  • Administer oxygen to maintain normal saturation. Intubate if necessary.
  • Initiate cardiopulmonary resuscitation (CPR) if the patient arrests. If she does not respond to resuscitation, perform a perimortem cesarean delivery.
  • Treat hypotension with crystalloid and blood products. Use pressors as necessary.
  • Avoid excessive fluid administration. During the initial phase, right ventricular function is suboptimal.  Excess fluid may overdistend the Right ventricle which could increase the risk of a right sided myocardial infarction.
  • Consider pulmonary artery catheterization in patients who are hemodynamically unstable.
  • Continuously monitor the fetus. Deliver immediately following cardiac arrest if gestational age is ≥ 23 weeks. [25]
  •  Early evaluation of clotting status and early initiation of massive transfusion protocols is recommended. [25]
  • Treat coagulopathy with FFP for a prolonged aPTT, cryoprecipitate for a fibrinogen level less than 100 mg/dL, and transfuse platelets for platelet counts less than 20,000/µL.
  • Lim and colleagues [29] reported a case of AFE in which the coagulopathy was treated with activated recombinant factor VIIa. The range of doses to treat serious bleeding is from 20-120 mcg/kg.
  • Hemodialysis with plasmapheresis [30] and extracorporeal membrane oxygenation (ECMO) with intra-aortic balloon counterpulsation [31] have been described in case reports with successful outcomes in treating AFE patients with cardiovascular collapse. The use of anticoagulation during ECMO may worsen bleeding in patients with AFE.  Use of ECMO is not routinely recommended. [25]

Consultations

Women who survive AFE will probably require ICU admission. Left heart failure is a common late occurrence. Additionally, survivors will probably have neurologic sequelae.

Therefore, consult the intensive care service in anticipation of transfer to that unit, and consult neurologists as needed if a patient shows signs of neurologic deficits.

Management should be by a multidisciplinary team including anesthesia, critical care, respiratory therapy, and maternal-fetal medicine. [25]

Transfer

Transfer to a level 3 hospital may be required once the patient is stable.

Next:

Surgical Care

Perform emergent cesarean delivery in arrested mothers who are unresponsive to resuscitation.

Goldszmidt and Davies [32] reported 2 cases of amniotic fluid embolism (AFE) in which the hemorrhage was controlled with bilateral uterine artery embolization. In both cases, bleeding was arrested with the procedure and both patients survived.

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