• Amniotic fluid embolism
    • 1:8000-80,000 births
      25% mortality
      Neonatal mortality 70%
      Usually occurs during labour
      (20% during c-section, 10% following vaginal birth)
    • Risks
      • Inc maternal age
      • Multiparity
      • IUD
      • Meconium ileus
      • Polyhydramnios
      • Strong frequent contractions
      • Maternal history of atopy
      • Chorioamnionitis
      • Uterine rupture
      • Placenta accreta
    • Signs and symptoms
      • Hypotension, arrhythmias, chest pain, PO.
      • Cyanosis, desaturation, bronchospasm, hypoxia.
      • DIC
    • Treatment
      • Supportive care
      • Deliver the baby
      • Treat uterine atony
      • Steroids?
      • Nitric oxide
      • Prostacyclin
      • Notifiable disease
    • Sialyl Tn antigen raised
      Zinc coproporphyrin raised
      Serum tryptase raised
    • Pathophysiology
      • Fetal debris enters maternal circulation usually via the lower segment/cervical region.
      • Phase I
        • PA vasospasm, RV failure, low SpO₂, CCF. Lasts 30 mins
      • Phase II
        • LVF, DIC, PO, haemorrhage, ARDS
      • Biochemical mediators
        • Endothelins, PLA2, collagen, IL1, TNF-α, PGs, leukotrienes
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/7/5/152.full.pdf