Rare but dangerous – Amniotic Fluid Embolism (AFE)

Everything was going according to plan. Helen and her husband could not wait to behold their little miracle of life. She had been rushed to hospital after the doctor confirmed that she was indeed in labour. The pain was almost unbearable but Helen had to persevere in order to see this much awaited gift.

In the maternity ward, all she could hear was ‘puuuush!’ over and over, and she did her best to propel her baby into the world. However, something was a miss, as her baby was not forth coming as was expected. Before long, she had passed out only to wake up hours later in the ICU, having undergone an emergency C-section. Thankfully, the baby had survived. The doctors told her she had a rare case of Amniotic fluid embolism.

Amniotic fluid embolism is a condition where large amounts of amniotic fluid suddenly enter the mother’s blood stream during labour. Amniotic fluid contains debris which can block blood vessels affecting clotting of blood. This can occur if labour is difficult, in older women, in dead foetus syndrome (a condition in which the foetus has died and remained in the uterus for some time), or if the baby is too large.

The condition can result in rapid death of the mother. The syndrome is -unpredictable and unpreventable.

Risk factors

» Turbulent labour
» Cesarean and instrumental delivery
» Advanced maternal age
» Foetal distress
» Placenta abruption or breaking away
» Eclampsia: Involves high blood pressure and convulsions
» Medical induction of labour
» Cervical lacerations or wounds

Signs and symptoms of AFE

» Acute shortness of breath

» Hypotension: Blood pressure may drop significantly Severe haemorrhage in absence of other explanation

» Dyspnea: Laboured breathing Cough: This is usually a manifestation of dyspnea Seizures

» Altered mental status/confusion/ agitation

» Foetal bradycardia: Foetal heart rate may drop to less than 110 beats per minute

» Pulmonary oedema: This is usually identified on chest radiograph.

» Cardiac arrest

» Uterine atony: Uterine atony usually results in excessive bleeding after delivery.

Causes

AFE is considered an unpredictable and unpreventable event with an unknown cause. Research shows that 41 per cent of patients had a history of allergies. The condition is so rare (between 1 in 8000 deliveries world wide). Therefore some doctors may never encounter it in their professional careers. As a result, the exact process is poorly understood. However, once the fluid and foetal cells enter the maternal pulmonary circulation a two-phase process occurs:

First phase
The patient experiences acute shortness of breath and hypotension (low blood pressure). This rapidly progresses to cardiac arrest as the chambers of the heart fail to dilate and there is a reduction of oxygen to the heart and lungs. Not long after this stage the patient will lapse into a coma.

Second phase
Although many women do not survive beyond the first stage, about 40 percent of the initial survivors will pass onto the second phase. This is known as the haemorrhagic phase and may be accompanied by severe shivering, coughing, vomiting, and the sensation of a bad taste in the mouth. This is also accompanied by excessive bleeding as the blood loses its ability to clot. Collapse of the cardiovascular system leads to foetal distress and death— unless the child is delivered swiftly.

Treatment
One approach which has been used is an immediate Caesarean section.

END: PG32/42