Amniotic fluid embolism

Amniotic fluid embolism

Definition  :

An amniotic fluid embolism is a rare but serious condition that occurs when amniotic fluid — the fluid that surrounds a baby in the uterus during pregnancy — or fetal material, such as hair, enters the maternal bloodstream.

An amniotic fluid embolism is most likely to occur during childbirth or immediately afterward.
An amniotic fluid embolism is difficult to diagnose. If your doctor suspects you might have an amniotic fluid embolism, you'll need immediate treatment to prevent potentially life-threatening complications.

Symptoms:

An amniotic fluid embolism develops suddenly and rapidly.
Signs and symptoms of an amniotic fluid embolism might include:

• Sudden shortness of breath
• Excess fluid in the lungs (pulmonary edema)
• Sudden low blood pressure
• Sudden circulatory failure (cardiovascular collapse)
• Life-threatening problems with blood clotting (disseminated intravascular coagulopathy)
• Altered mental status, such as anxiety
• Nausea or vomiting
• Chills
• Rapid heart rate or disturbances in the rhythm of the heart rate
• Fetal distress, such as a slow heart rate
• Seizures
• Coma

Causes:

Why an amniotic fluid embolism occurs isn't well understood.
An amniotic fluid embolism occurs when amniotic fluid or fetal material enters the maternal bloodstream, possibly by passing through tears in the fetal membranes. It's likely that amniotic fluid contains components that cause an inflammatory reaction and activate clotting in the mother's lungs and blood vessels.

However, amniotic fluid embolisms are rare — and it's likely that some amniotic fluid commonly enters the maternal bloodstream during delivery without causing problems. It's not clear why in some cases this leads to an amniotic fluid embolism.
Further research on what causes amniotic fluid embolisms is needed.


Complications:

An amniotic fluid embolism can cause serious complications for you and your baby.
If you have an amniotic fluid embolism, you're at increased risk of:

• Brain injury. Low blood oxygen can cause permanent, severe neurological damage or brain death.
  
• Lengthy hospital stay. Women who survive an amniotic fluid embolism often require treatment in the intensive care unit and — depending on the extent of their complications — might spend weeks or months in the hospital.

It's estimated that amniotic fluid embolisms cause up to 10 percent of maternal deaths in developed countries. Death can occur within an hour of the start of symptoms.
If you have an amniotic embolism, your unborn baby is at increased risk of a brain injury due to a lack of oxygen. The condition can also be fatal for babies.

Treatments and drugs :

An amniotic fluid embolism requires rapid treatment to address low blood oxygen and low blood pressure.
Emergency treatments might include:

• Catheter placement. Your health care team will place a thin, hollow tube into one of your arteries (arterial catheter) to monitor your blood pressure. You'll also have another tube placed into a vein in your chest (central venous catheter), which can be used to give fluids, medications or transfusions, as well as draw blood.
  
• Oxygen. You might need to have a breathing tube inserted into your airway to help you breathe.
  
• Medications. Your doctor might give you medications to improve and support your heart function. Other medications might be used to decrease the pressure caused by fluid going into your heart and lungs.
  
• Transfusions. If you have uncontrollable bleeding, you'll need transfusions of blood, blood products and replacement fluids.

If you have an amniotic fluid embolism before delivering your baby, your doctor will treat you with an eye toward safely delivering your baby as soon as possible. An emergency C-section might be needed.