Amniotic fluid embolism

Thought to result from maternal reaction to fetal material entering the pulmonary circulation, and may be associated with apnea, bradycardia and hypotension.

Complicates 1in 10,000 and 1in 100,000 deliveries.

Can be associated with vaginal and cesarean deliveries.

Can occur at any time during labor, and delivery and during the postpartum period.

Risk factors include: advanced maternal age, precipitous labor, cesarean delivery, bleeding situations of pregnancy.

Considered unpredictable and unpreventable.

Clinical presentation includes cardiovascular collapse, apnea, fetal compromise, and bleeding.

Agitation and anxiety often precedes findings of cardiovascular changes.

Associated with maternal anaphylactic reaction with 2 phases.

The first phase lasts less than 30 minutes and is associated with pulmonary vasoconstriction, pulmonary hypertension,and right sided heart failure.

The second phase involves left sided heart failure, endothelial abnormalities with pulmonary leakage, and bleeding, as a result of first phase hypoxemia and release of cytokines.

A leading cause of maternal death in the developed word.

Accounts for approximately 5% of maternal deaths.

Mortality rates about 20%.

Treatment is supportive care: oxygen, airway maintenance, early fluid resuscitation, pressors may be needed, treatment of bleeding coagulopathy, and uterine atony.

Treatment of uterine atony may include uterotonic drugs such as ergot derivatives, prostaglandins, andintrauterine ballon tamponade.

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