Amniotic fluid embolus

Background

• Diagnosis of exclusion
• Maternal mortality rate ~80%; 85% of survivors have neurologic sequelae

Risk Factors

• Cesarean delivery
• Advanced maternal age
• Abnormal placental implantation
• Uterine rupture
• Eclampsia
• Amniocentesis
• Trauma

Clinical Features

• Any of the following:
  • Respiratory distress
  • Pulmonary edema
  • Hypoxia
  • AMS
  • Seizures
  • Sudden maternal cardiovascular collapse
  • DIC

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

• Acute fatty liver of pregnancy
• Amniotic fluid embolus
• Chorioamnionitis
• Eclampsia
• HELLP syndrome
• Mastitis
• Peripartum cardiomyopathy
• Postpartum endometritis (postpartum PID)
• Postpartum headache
• Postpartum hemorrhage
• Preeclampsia
• Resuscitative hysterotomy
• Retained products of conception
• Septic abortion
• Uterine rupture

Management

• Treat hypoxia
  • NRB or intubate
• Treat hypotension
  • Pressors / blood products
• Avoid hypoperfusion
  • Place patient in left lateral decubitus position
• Immediate delivery of fetus:
  • Perimortem C-section within 5min of cardiac arrest if mother cannot be resuscitated

Disposition

• Admit

See Also

• Post-Partum Emergencies