Amniotic fluid embolism
|Amniotic fluid embolism|
|Other names: Anaphylactoid syndrome of pregnancy|
|Skin cells are present in the blood vessels of this case of amniotic fluid embolism.|
|Symptoms||Headache, chest pain, nausea, shortness of breath|
|Complications||Bleeding problems, coma, cardiac arrest|
|Causes||Allergic reaction to fetal tissue that has entered the mother's blood stream|
|Diagnostic method||Based on symptoms, after ruling out other causes|
|Differential diagnosis||Eclampsia, pulmonary embolism, placental abruption, peripartum cardiomyopathy, air embolism, hemorrhagic shock|
|Treatment||Supportive care, rapid delivery|
|Frequency||1 in 40,000 deliveries|
|Deaths||~40% risk of death|
Amniotic fluid embolism (AFE) is a complication around childbirth in which fetal tissue enters the blood stream of the mother resulting in health problems. Onset is rapid. Initial symptoms may include headache, chest pain, nausea, and shortness of breath. This may be followed by bleeding problems, coma, or cardiac arrest.
Risk factors are unclear; though those affected may more commonly have allergies. The underlying mechanism is believed to involve an allergic reaction to fetal tissue that has entered the mother's blood. Diagnosis is based on symptoms, particularly low oxygen and low blood pressure, after ruling out other possible causes.
Treatment is generally supportive care. This may include oxygen therapy, intubation and ventilation, blood transfusions, or cardiopulmonary resuscitation (CPR). If delivery has not yet occurred, rapid delivery may be required. Of those who survive, some have brain damage while others return to normal.
Amniotic fluid embolism occurs in about 1 in 40,000 deliveries. Older mothers are more commonly affected. Of those affected about 40% die. It is a relatively common cause of death during pregnancy, representing about 7.5% of such deaths in the United States. The condition was first described in 1926.
Signs and symptoms
The disorder occurs during the last stages of labor if amniotic fluid enters the circulatory system of the mother via tears in the placental membrane or uterine vein rupture. Fetal cells are found in the maternal circulation. When the fetal cells and amniotic fluid enter the bloodstream, reactions occur that affect blood clotting. Disseminated intravascular coagulation occurs and results in serious bleeding. The condition can also develop after elective abortion, amniocentesis, cesarean delivery, or trauma. Small lacerations in the lower reproductive tract are also associated with AFE.
AFE is diagnosed when other causes have been excluded. Fetal squamous cells or other fetal tissues, including meconium, have been found in the maternal circulation after the event. Diagnosis is also based upon symptoms.
Treatment is generally supportive care. This may include oxygen therapy, intubation and ventilation, blood transfusions, or cardiopulmonary resuscitation (CPR). If delivery has not yet occurred, rapid delivery may be required.
This rare complication has been recorded seventeen times prior to 1950. The complication was originally described in 1926 by J. R. Meyer at the University of Sao Paulo. A 1941 case study of eight autopsies of pregnant women who died suddenly during childbirth by Clarence Lushbaugh and Paul Steiner enabled widespread recognition of the diagnosis within the medical community, and was eventually republished as a landmark paper in the Journal of the American Medical Association.
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