Definition:

-rare obstetric emergency in which

amniotic fluid, fetal cells, hair, or other
debris enter the maternal circulation,
causing cardiorespiratory collapse and
coagulopathy. (Mortality rate: 60-80%)
-occurs during labor,
immediately postpartum.

delivery,

or

Etiology:
1.Breach in vein or blood sinus at the
trauma site of cervix and body of the
uterine.
2.Higher pressure of amniotic cavity.
3.Disruption of fetal membrane.

Risk factors:
Age 30+
Multiparity
Intense uterine contraction
Medical induction of labor
Amnioinfusion
Placental abruption
Meconium staining of AF
Premature placental separation
High cervical tears
C/S delivery
Intrauterine fetal death

Pathophysiology:
1.Amniotic

fluid reaches the maternal

intravascular compartment (systemic
venous system).
2.AF

enters pulmonary circulation via

pulmonary artery. This contaminated blood
crosses to left atrium through patent
foramen and intrapulmonary shunts once
embolism is significant.

3. Exposure of pulmonary vasculature to both

soluble and insoluble components of AF and other
mediators released locally induces capillary leak,
negative inotropism, and bronchospasm, resulting
in sudden onset of respiratory distress and
cyanosis.
4. Within minutes, negative inotropic effect
becomes prevalent. Pulmonary venous pressure
(congestion) increases and drop in CO are
manifested by pulmonary edema and hypotension
to the point of shock.

5. Exposure of the intravascular compartment to

AF thromboplastin and other mediators freed in
circulation by presence of AF induces a
consumptive coagulopathy. DIC results in severe
uterine bleeding.
6. Resultant systemic hypotension decreases
uterine perfusion. Abnormalities of fetal heart
tracing will rapidly follow and results in fetal
death.

Cardinal criteria for AFE:

Acute

hypotension or cardiac arrest

Acute hypoxia
Coagulopathy or severe clinical
hemorrhage in the absence of other
explanations
All of these occurring during labor, C/S
delivery, D&C or within 30 mins postpartum,
with no other explanations

Treatment:
1.Treat

hypoxia with 100% oxygen.

2.Treat hypotension by fluid resuscitation with
isotonic solutions and vasopressors (such as
dopamine infusion for myocardial support; ephedrine or
levarterenol for VT to reduce systemic vascular
resistance).
3.Treat left ventricular diminished contractility with
fluids and inotropic therapy.
4.Treat DIC and coagulopathy with fresh frozen
plasma, cryoprecipitate, fibrinogen and factor
replacement.
5.Treat hemorrhage with RBC transfusions and
thrombocytopenia with platelets.

Prognosis:
Very

poor
Neonatal survival at 70%
50% die within first hour of onset of
symptoms
50% survivors of Phase 1 develop
coagulopathy
Risk of recurrence is unknown

-END OF LECTURE-

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