Amniotic Fluid Embolism

An amniotic fluid embolism can be a devastating blow to what was supposed to be a joyful experience. Little is known about AFE (as it’s commonly referred to), as it’s classified as unpredictable, unpreventable, and untreatable. In a normal patient, amniotic fluid doesn’t enter the maternal circulation as is deemed safely contained inside the uterus, sealed off by the amniotic sac. AFE occurs when the barrier between the amniotic fluid and maternal circulation is broken, and the amniotic fluid enters the maternal venous system. The reasons why this occurs in some women and not others is still very much misunderstood in the medical community. Health care providers are given 1-3 minutes to notice symptoms, properly diagnose the problem and react to the mother who begins to enter phase one of the two phases of AFE.

During phase one, the patient begins to experience a shortness of breath and hypotension. Cardiac arrest quickly follows, as the chambers of the heart fail to dilate and produce oxygen to the heart and lungs. Within moments most patients lapse into a coma. 60-80% of patients do not make it through this first phase of amniotic fluid embolism.

With almost 40% of patients who do survive, they begin to enter into the second phase of AFE. Experts refer to the second phase as the hemorrhagic phase, which is often times accompanied by severe shivering, coughing, vomiting, excessive bleeding, blood clots, and the sensation of a bad taste in the mouth. The collapse of the cardiovascular system leads to fetal distress, which leads to death of the infant if he or she is not delivered immediately.

This condition is truly devastating, as there are no warning signs, little research, no known prevention or treatments steps, and no diagnostic tests available. Because there is no diagnostic tests available, experts rely on the following information to diagnose a patient:

1. Acute hypotension or cardiac arrest

2. Acute hypoxia

3. Coagulopathy or severe hemorrhage in the absence of other explanations

4. All of the above occurring during labor, caesarean deliveries, dilation and evacuation, or within 30 minutes postpartum without other explanations

Amniotic Fluid Embolism Facts

Here are some known facts about this unknown condition:

• AFE does not discriminate against any race
• AFE does not discriminate against any age
• AFE only occurs in woman
• AFE occurs during pregnancy
• AFE can occur during an abortion
• Condition is so rare, experts can not say accurately how often it occurs
• Suspected to occur at a rate of 1 in 21,000 pregnancies
• Fatalities occur in 61% of all cases in the US (46 last year)
• 50% die within the first hour of onset symptoms
• Survival is uncommon
• Survivors suffer from permanent neurologic impairments
• Increased risk in women over the age of 30
• No definite diagnostic test exists today

Amniotic Fluid Embolism Symptoms

Experts still disagree on exact symptoms to watch for, since in up to 80% of all cases, the diagnosis isn’t made until the mother and/or infant has already passed away. Still, the symptoms listed below were common enough in women leading up to and during the problem for experts to agree on. However, many experts still believe that AFE can not be predicted or prevented.

• Hypotension (low blood pressure)
• Dyspnea
• Seizure
• Cough
• Fetal slow heartbeat
• Cardiac arrest
• Shock
• Respiratory distress
• Cyanosis
• Pulmonary edema
• Confusion
• Loss of consciousness
• Cardiorespiratory arrest
• Hemorrhaging

Amniotic Fluid Embolism Causes

Although experts can not truly pinpoint the exact cause of AFE, many agree that the condition is the result of amniotic fluid entering the uterine veins. In order for this to occur, experts believe one or more of the following has to happen to lead to AFE:

• Ruptured membranes
• Ruptured uterine or cervical veins
• A pressure gradient from uterus to vein
• Abdominal trauma
• Amniocentesis

Again, there is no scientific proof stating any of these is the cause for AFE. However, ever since more and more people are becoming aware of the condition, extensive research and studies are being conducted to finally receive reliable answers.

Amniotic Fluid Embolism Treatment

Treatment is almost always unnecessary, as most patients are not diagnosed with amniotic fluid embolism until an autopsy is performed. If a patient survives the first phase, resuscitation should immediately follow, and the patient should be placed on life support and moved into an obstetric intensive care unit for around-the-clock supervision. If the hospital does not have an obstetric intensive care unit, then the patient will more than likely be moved to a surgical intensive care unit. If the fetus is still alive, he or she will need to be monitored closely for signs of a problem. Ironically, many critical care nurses find themselves trying to save the life of the mother, while statistics show a higher maternal morbidity rate than the fetus morbidity rate.