Amniotic fluid embolism
| Amniotic fluid embolism | |
|---|---|
| Classification and external resources | |
| Specialty | obstetrics |
| ICD-10 | O88.1 |
| ICD-9-CM | 673.1 |
| DiseasesDB | 574 |
| eMedicine | med/122 |
| MeSH | D004619 |
An amniotic fluid embolism (AFE) is a rare childbirth (obstetric) emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and triggers an allergic-like reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and massive bleeding (coagulopathy). It was first formally characterized in 1941. While it is rare (between 1 in 8,000 and 1 in 80,000 deliveries), the high mortality makes it the fifth most common cause of maternal mortality in the world, in some estimates.
The condition is rare (between 1 in 8,000 and 1 in 80,000 deliveries).
When the fluid and fetal cells enter the maternal pulmonary circulation there is profound respiratory failure with deep cyanosis and cardiovascular shock followed by convulsions and profound coma, in a first and second phase.
In the first phase, the patient experiences acute shortness of breath and low blood pressure. This rapidly progresses to heart failure leading to a reduction of perfusion to the heart and lungs. This may be accompanied by other "premonitory symptoms" such as shivering, coughing, vomiting, and an unpleasant taste in the mouth. Not long after this stage the patient will lose consciousness due to circulatory collapse. While previously believed to have a maternal mortality rate of 60-80%, more recently it has been reported at 26.4%.
About 40 percent of the initial survivors will pass onto the hemorrhagic phase. The blood loses its ability to clot and there is excessive bleeding. Collapse of the cardiovascular system leads to fetal distress and death unless the child is delivered swiftly.
It is thought that this condition results from amniotic fluid entering the maternal circulation via the uterine veins, which then has either a direct effect on the lungs, or triggers an immune response in the mother.
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