Amniotic fluid embolism, introduction, definition, risk factors, fetal factors, causes, symptoms, incidence, investigation, treatment, nursing care

1. MIDWIFERY & OBSTETRICAL NURSING
OBSTRETICAL EMERGENCY: AMNIOTIC FLUID EMBOLISM
PREPARED BY DOLISHA WARBI

2. INTRODUCTION:
Amniotic fluid embolism is a rare obstetrics emergency and frequently
results in death or neurologic impairments of the woman and her fetus.
Recently known as anaphylactoid syndrome of pregnancy.

3. DEFINITION:
Amniotic fluid embolism (AFE) is a rare and life-threatening complication
that occurs when a pregnant person gets amniotic fluid into their
bloodstream just before, during or immediately after childbirth.
RISK FACTOR:
ØOlder maternal age.
ØMultiparity.
ØIntense contractions during labor.
ØAbdominal trauma.
ØCesarean section.
ØInduction of labour.

4. ØPlacenta previa.
ØEclampsia.
ØMultiple pregnancy.
ØTears in the uterus or cervix.
ØEarly separation of the placenta from the uterus wall.
FETAL FACTORS:
ØFoetal distress.
ØFoetal death.

5. CAUSES:
• Abortion.
• Amniotic fluid examination (amniocentesis).
SYMPTOMS:
• Fetal distress (signs that the baby is unwell, including changes in
the fetal heart rate or decreased movement in the womb)
• Vomiting
• Nausea
• Seizures
• Severe anxiety, agitation
• Skin discoloration

6. INCIDENCE:
• Occurs in 1 in 20,000 to 1 in 80,000 pregnancies.
INVESTIGATIONS:
ØABGs.
ØBleeding time are usually prolonged.
ØECG – evidence by right side heart failure.
ØX – ray.
ØLaboratory tests.

7. TREATMENT:
Urgent treatment include;
ØOxygen endotracheal intubation and positive pressure respiration.
ØAminophylline: 0.5gm in IV to reduce bronchospasms.
ØIsoprenaline: 0.1gm iv to improve pulmonary blood flow.
ØDigoxin and atropine if central venous pressure raised and pulmonary
secretion is excessive.
ØHydrocortisone: 1gm iv improve tissue perfusion.
ØBicarbonate solution incase of respiratory acidosis.
ØHeparin: if there is no active bleeding treatment of DIC (Disseminated
intravascular coagulation).
ØIn case of full cardiopulmonary arrest. Quickly advanced cardiac life
support, including mechanical intubations and ventilation, is required.

8. CONT..
ØDelivery of the infant by Cs within 5 min after the start of CPR is
recommended.
ØDIC (disseminated intravascular coagulopathy) is treated with fluid
restoration and blood product replacement therapy.
ØVaginal delivery is safer than cesarean section if the baby is not yet
delivered.
NURSING CARE:
qIn case of dyspnoea during labor or postpartum woman immediate
nursing assistant is required.
qMonitor and maintain vital signs.
qAdministered oxygen through face mask.

9. CONT..
qInitiate CPR if required and assist cesarean delivery at bed side.
qBe prepare to administered fluid and blood product if needed.
qAnticipate transfer to the ICU as soon as the woman is stable enough
to transfer.