Amniotic fluid embolism - Wikipedia, the free encyclopedia

21/03/15 09:29

Amniotic fluid embolism

From Wikipedia, the free encyclopedia

Amniotic fluid embolism (AFE) is a

rare 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 trigger an allergic reaction.
This reaction then results in
cardiorespiratory (heart and lung)
collapse and coagulopathy. It was first
formally characterized in 1941.[2]
While it is rare (between 1 in 8000
and 1 in 80,000 deliveries) the high
mortality leads it to be the fifth most

Amniotic fluid embolism

Classification and external resources
ICD-10

O88.1
(http://apps.who.int/classifications/icd10/browse/2015/en#/O88.1)

ICD-9

673.1 (http://www.icd9data.com/getICD9Code.ashx?icd9=673.1)

DiseasesDB 574 (http://www.diseasesdatabase.com/ddb574.htm)

eMedicine med/122 (http://www.emedicine.com/med/topic122.htm)
MeSH

D004619 (https://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?
field=uid&term=D004619)

common cause of maternal mortality in the world, in some estimates.[3]

Contents
1 Presentation
1.1 First phase
1.2 Second phase
2 Causes

Presence of intravascular squames in

amniotic fluid embolism

3 Treatment
4 Recurrence
5 References
6 External links

Presentation
The condition is rare (between 1 in 8000 and 1 in 80,000 deliveries).[4]
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.

First phase
http://en.wikipedia.org/wiki/Amniotic_fluid_embolism

Pgina 1 de 4

Amniotic fluid embolism - Wikipedia, the free encyclopedia

21/03/15 09:29

In the first phase, the patient experiences acute shortness of breath and
hypotension. This rapidly progresses to cardiac 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%.[5]

Second phase
About 40 percent of the initial survivors will pass onto the hemorrhagic
phase 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.

Causes
It is thought that this condition results from amniotic fluid entering the
maternal circulation via the uterine veins, which then has either a direct

Pathophysiology of the amniotic fluid

embolism[1]

effect on the lungs, or triggers an immune response in the mother.[6]

In order for amniotic fluid to enter the maternal circulation, there are three prerequisites:
Ruptured membranes (a term used to define the rupture of the amniotic sac)
Ruptured uterine or cervical veins
A pressure gradient from uterus to vein
Although exposure to fetal tissue is common and thus finding fetal tissue within the maternal circulation is not
significant, in a small percentage of women this exposure leads to a complex chain of events resulting in
collapse and death.
There is some evidence that AFE may be associated with abdominal trauma [4] or amniocentesis.[7] A 2006
study showed that the use of drugs to induce labor, such as misoprostol, nearly doubled the risk of AFE. A
maternal age of 35 years or older, caesarean or instrumental vaginal delivery, polyhydramnios, cervical
laceration or uterine rupture, placenta previa or abruption, eclampsia, and fetal distress were also associated
with an increased risk.[8]

Treatment
There is no specific treatment for amniotic fluid embolism, and initial emergency management is the same as for
any other cause of sudden maternal collapse - with cardiovascular and respiratory resuscitation and correction
of the coagulopathy.[9] However, newer research with animal models suggest that significant embolism of any
http://en.wikipedia.org/wiki/Amniotic_fluid_embolism

Pgina 2 de 4

Amniotic fluid embolism - Wikipedia, the free encyclopedia

21/03/15 09:29

material is followed by platelet degranulation, pulmonary hypertension due to serotonin and thromboxane, and
systemic hypotension due to vagal stimulation. Armed with this knowledge, several women have survived and
regained a pulses immediately after ondansetron, metoclopramide, atropine, and ketorolac were
administered.[10][11] One emergency intervention which has been applied is an immediate caesarean section.[12]

Recurrence
According to review published in 2009, a total of 9 cases of successful pregnancy following AFE, with no
instances of recurrent AFE, have been reported in the literature. Therefore, although the available information is
limited, the current evidence suggests that AFE is not a recurrent disease.[13]

References
1. Alfredo Gei, Gary D. V. Hankins: Amniotic fluid embolus: An update. Contemp Ob/Gyn 45 (2000), pp. 5366, online
(http://www.modernmedicine.com/modernmedicine/Amniotic+Fluid/Amniotic-fluid-embolus-Anupdate/ArticleStandard/Article/detail/139541).
2. Stafford I, Sheffield J (2007). "Amniotic fluid embolism" (http://linkinghub.elsevier.com/retrieve/pii/S08898545(07)00065-4). Obstet. Gynecol. Clin. North Am. 34 (3): 54553, xii. doi:10.1016/j.ogc.2007.08.002
(https://dx.doi.org/10.1016%2Fj.ogc.2007.08.002). PMID 17921014 (https://www.ncbi.nlm.nih.gov/pubmed/17921014).
3. Moore J, Baldisseri MR (2005). "Amniotic fluid embolism" (http://meta.wkhealth.com/pt/pt-core/templatejournal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=33&issue=10&spage=S279). Crit. Care Med. 33
(10 Suppl): S27985. doi:10.1097/01.CCM.0000183158.71311.28
(https://dx.doi.org/10.1097%2F01.CCM.0000183158.71311.28). PMID 16215348
(https://www.ncbi.nlm.nih.gov/pubmed/16215348).
4. Ellingsen CL, Eggeb TM, Lexow K (2007). "Amniotic fluid embolism after blunt abdominal trauma"
(http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(07)00097-4). Resuscitation 75 (1): 1803.
doi:10.1016/j.resuscitation.2007.02.010 (https://dx.doi.org/10.1016%2Fj.resuscitation.2007.02.010). PMID 17467876
(https://www.ncbi.nlm.nih.gov/pubmed/17467876).
5. Gilbert WM, Danielsen B (June 1999). "Amniotic fluid embolism: decreased mortality in a population-based study".
Obstet Gynecol 93 (6): 9737. doi:10.1016/s0029-7844(99)00004-6 (https://dx.doi.org/10.1016%2Fs00297844%2899%2900004-6). PMID 10362165 (https://www.ncbi.nlm.nih.gov/pubmed/10362165).
6. N J McDonnell, V Percival, M J Paech (Aug 2013). "Amniotic fluid embolism: a leading cause of maternal death yet still
a medical conundrum" (http://www.obstetanesthesia.com/article/S0959-289X(13)00115-5/abstract). International
journal of obstetric anesthesia. doi:10.1016/j.ijoa.2013.08.004 (https://dx.doi.org/10.1016%2Fj.ijoa.2013.08.004).
7. Dodgson J, Martin J, Boswell J, Goodall HB, Smith R (May 1987). "Probable amniotic fluid embolism precipitated by
amniocentesis and treated by exchange transfusion" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1246486). Br Med
J (Clin Res Ed) 294 (6583): 13223. doi:10.1136/bmj.294.6583.1322
(https://dx.doi.org/10.1136%2Fbmj.294.6583.1322). PMC 1246486
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1246486). PMID 3109636
(https://www.ncbi.nlm.nih.gov/pubmed/3109636).

http://en.wikipedia.org/wiki/Amniotic_fluid_embolism

Pgina 3 de 4

Amniotic fluid embolism - Wikipedia, the free encyclopedia

21/03/15 09:29

8. Kramer, M.S.; Rouleau, Jocelyn; Baskett, Thomas F; Joseph, KS (2006). "Amniotic-fluid embolism and medical
induction of labour: a retrospective, population-based cohort study"
(http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69607-4/abstract). The Lancet 368 (9545): 1444
1448. doi:10.1016/S0140-6736(06)69607-4 (https://dx.doi.org/10.1016%2FS0140-6736%2806%2969607-4).
PMID 17055946 (https://www.ncbi.nlm.nih.gov/pubmed/17055946).
9. N.F. Collins, M. Bloor, N.J. McDonnell (2013). "Hyperfibrinolysis diagnosed by rotational thromboelastometry in a case
of suspected amniotic fluid embolism" (http://www.obstetanesthesia.com/article/S0959-289X(12)00131-8/abstract).
International Journal of Obstetric Anesthesia 22 (1): 7176. doi:10.1016/j.ijoa.2012.09.008
(https://dx.doi.org/10.1016%2Fj.ijoa.2012.09.008).
10. http://soap.org/display_2013_abstract.php?id=S%2047
11. http://www.marchofdimes.org/pdf/missouri/AFE_11-21-13.pdf
12. Stehr SN, Liebich I, Kamin G, Koch T, Litz RJ (2007). "Closing the gap between decision and delivery--amniotic fluid
embolism with severe cardiopulmonary and haemostatic complications with a good outcome"
(http://linkinghub.elsevier.com/retrieve/pii/S0300-9572(07)00017-2). Resuscitation 74 (2): 37781.
doi:10.1016/j.resuscitation.2007.01.007 (https://dx.doi.org/10.1016%2Fj.resuscitation.2007.01.007). PMID 17379383
(https://www.ncbi.nlm.nih.gov/pubmed/17379383).
13. Conde-Agudelo, Agustn; Romero, Roberto (2009). "Amniotic fluid embolism: an evidence-based review". American
Journal of Obstetrics and Gynecology 201 (5): 445.e1445.e13. doi:10.1016/j.ajog.2009.04.052
(https://dx.doi.org/10.1016%2Fj.ajog.2009.04.052). ISSN 0002-9378 (https://www.worldcat.org/issn/0002-9378).

External links
Histology (http://library.med.utah.edu/WebPath/FORHTML/FOR090.html) at University of Utah
Retrieved from "http://en.wikipedia.org/w/index.php?title=Amniotic_fluid_embolism&oldid=652039590"
Categories: Pathology of pregnancy, childbirth and the puerperium Complications of labour and delivery
This page was last modified on 19 March 2015, at 06:16.
Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may
apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia is a registered
trademark of the Wikimedia Foundation, Inc., a non-profit organization.

http://en.wikipedia.org/wiki/Amniotic_fluid_embolism

Pgina 4 de 4