The resultant ventricular failure leads to pulmonary edema and hypotension. If the mother survives this first insult, severe dilatation of the right ventricle causes relative left ventricular compression and elevated filling pressures with decreased left ventricular volume and stroke volume. Vasospasm of the pulmonary vasculature, hypoxia, and a rapid rise in right ventricular pressure leads to acute right heart failure and, in many cases, cardiac arrest. The acute onset of cardiovascular collapse is thought to result from an overwhelming activation of maternal inflammatory mediators in response to the fetal material. It is hypothesized that the disruption of the maternal-fetal barrier in labor allows for the passage of amniotic fluid, fetal cells, or other fetal debris into the maternal blood circulation, which in rare cases can trigger an anaphylactoid-type reaction. The exact pathogenesis of AFE remains unclear. Typically occurring during labor or shortly after delivery of the placenta, it is characterized by the sudden onset of cardiovascular and respiratory failure with no other identifiable cause followed by the rapid onset of disseminated intravascular coagulopathy ( DIC). PMID: 20956228.Īmniotic fluid embolism ( AFE) is a rare (1-2/100,000 deliveries) but frequently catastrophic obstetric emergency. Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Jeejeebhoy FM, Zelop CM, Lipman S, et al American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. PMID: 31644848.Įxtracorporeal Life Support Organization. Case 33-2019: A 35-Year-Old Woman with Cardiopulmonary Arrest during Cesarean Section. PMID: 31714909 PMCID: PMC6850527.īernstein SN, Cudemus-Deseda GA, Ortiz VE, Goodman A, Jassar AS. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. Further research on the treatment of this condition is necessary.Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, et al. Among women with an AFE, common demographic or obstetrical determinants were not predictive of maternal mortality.ĬONCLUSION: AFE is a rare but serious condition that is associated with advanced maternal age, placental pathologies, and cesarean deliveries. Although AFEs were not significantly associated with induction of labor (OR 1.5, 95% CI 0.9 to 2.3), they were associated with preeclampsia, abruptio placentae, and the use of forceps. AFE was associated with maternal age greater than 35 (OR 2.2, 95% CI 1.5 to 2.1), placenta previa (OR 30.4, 95% CI 15.4 to 60.1), and cesarean delivery (OR 5.7, 95% CI 3.7 to 8.7). RESULTS: The overall incidence of AFE was 7.7 per 100,000 births (95% CI 6.7 to 8.7), with a case fatality rate of 21.6% (95% CI 15.5 to 27.6%). Logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (CIs) of demographic and obstetrical determinants of AFEs and fatal AFEs. STUDY DESIGN: We conducted a population-based cohort study on 3 million birth records in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2003 to estimate the incidence and case fatality of AFEs. Given the rarity of its occurrence, current estimates and predictors of the incidence and outcomes are often difficult to obtain. OBJECTIVE: Amniotic fluid embolism (AFE) is a condition occurring during delivery that can lead to severe maternal morbidity and mortality.
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