Case Study Labour Room

WIDAD UNIVERSITY COLLEGE

FACULTY OF ALLIED HEALTH SCIENCES

CASE STUDY

AMNIOTIC FLUID EMBOLISM

POSTING UNIT: LABOR ROOM, HOSPITAL TENGKU AMPUAN AFZAN (HTAA), KUANTAN, PAHANG.

NAME: MOHAMAD RAIS BIN MOHD SHUHAIMI MATRIC MATRIC NUMBER: SP511!"!# I$C NUMBER: #!"%&'"'5%!#

CONTENTS

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DEFINITION  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 fetal cells, enters the mother's bloodstream.  Amniotic fluid embolism is most likely to occur during delivery or  immediately afterward.

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 effect on the lungs, or triggers an immune response in the mother. In order for amniotic fluid to enter the maternal circulation, there are three prerequisites:

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Ruptured membranes a term used to define the rupture of  the amniotic sac!

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Ruptured uterine or cervical veins

 A pressure gradient from uterus to vein

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 Although e"posure to fetal tissue is common and thus finding fetal tissue within the maternal circulation is not significant, in a small percentage of  women this e"posure leads to a comple" chain of events resulting in collapse and death. #here is some evidence that Amniotic $luid %mbolism A$%! may be associated with abdominal trauma or amniocentesis. A &( study showed that the use of drugs to induce labor, such as misoprostol, nearly doubled the risk of A$%. A maternal age of )* 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.

SIGNS AND SYMPTOMS +igns and symptoms of amniotic fluid embolism might include:

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+udden shortness of breath

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%"cess fluid in the lungs pulmonary edema!

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+udden low blood pressure

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+udden failure of the heart to effectively pump blood cardiovascular  collapse!

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ife-threatening

problems

with

blood

clotting

disseminated

intravascular coagulopathy!

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 Altered mental status, such as an"iety

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hills

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Rapid heart rate or disturbances in the rhythm of the heart rate

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$etal distress, such as a slow heart rate

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+ei/ures

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oma

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+udden fetal heart rate abnormalities

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0leeding from the uterus, incision or intravenous I1! sites

DIAGNOSIS

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#he diagnosis of amniotic fluid embolism is based on a doctor's evaluation.  A diagnosis is typically made after other conditions have been ruled out. In some cases, a diagnosis is only made after maternal death.

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0lood tests, including those that evaluate clotting, heart en/ymes, electrolytes and blood type, as well as a complete blood count 0!

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%lectrocardiogram %2 or %32! to evaluate heart rhythm

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4ulse o"imetry to check the amount of o"ygen in blood

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hest 5-ray to look for fluid around heart

•

%chocardiography to evaluate heart function

MANAGEMENT M3+9/8 C/  Admit the patient with amniotic fluid embolism A$%! into the intensive care unit I6!. #reatment is supportive and includes the following:

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 Administer o"ygen to maintain normal saturation. Intubate if  necessary.

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Initiate cardiopulmonary resuscitation 4R! if the patient arrests. If she does not respond to resuscitation, perform a perimortem cesarean delivery.

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#reat hypotension with crystalloid and blood products. 6se pressors as necessary.

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 Avoid e"cessive fluid administration. 7uring the initial phase, right ventricular function is suboptimal. %"cess fluid may overdistend the Right ventricle which could increase the risk of a right sided myocardial infarction.

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onsider pulmonary artery catheteri/ation in patients who are hemodynamically unstable.

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ontinuously monitor the fetus. 7eliver immediately following cardiac arrest if gestational age is 8 &) weeks. %arly evaluation of  clotting status and early initiation of massive transfusion protocols is recommended.

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#reat coagulopathy with fresh fro/en plasma $$4! for a prolonged activated partial thromboplastin time a4##!, cryoprecipitate for a

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fibrinogen level less than 9 mgd, and transfuse platelets for  platelet counts less than &,;. ! with

intra-aortic

balloon

counterpulsation have been described in case reports with successful outcomes in treating A$% patients with cardiovascular  collapse. #he use of anticoagulation during %=> may worsen bleeding in patients with A$%. 6se of %=> is not routinely recommended. S02+9/8 C/ 4erform emergent cesarean delivery in arrested mothers who are unresponsive to resuscitation.

COMPLICATIONS  Amniotic $luid %mbolism A$%! can be fatal, especially during the first stage. =ost A$% deaths occur due to the following: 6

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sudden cardiac arrest

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e"cessive blood loss

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acute respiratory distress

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multiple organ failure

PROGNOSIS +urvival after Amniotic $luid %mbolism A$%! has improved significantly with early recognition of this syndrome and prompt and early resuscitative measures. #he decrease in the mortality rate results solely from early diagnosis and prompt treatment rather than prevention of the syndrome, since the cause is unknown. #hose women who survive long enough to be transferred to the I6 have a better chance of survival. Although mortality rates have declined, morbidity remains high with severe sequelae, particularly neurologic impairment.

REFERENCES ;--6:$$