AFE
4/10/10
CEPD October 2007
OHOA
Critical Care Clinics 20 (2004) pg 643-650
OH
General
-
diagnosis of exclusion
amniotic in maternal circulation not always pathognomonic
1:25,000 live births
3rd most common cause of maternal death (UK)
1st most common cause of maternal death (Australasia)
mortality 50% in first hour -> if patients survive usually have neurological deficits.
Pathophysiology
-?
- probably due to an anaphylactic rxn to fluid or fetal tissue
- intravascular entry of prostaglandins, leukotrienes, endothelin and fetal debris
- within 30min -> complement activation + intense pulmonary vasoconstriction -> right heart
failure -> hypoxia, hypercarbia & acidosis -> left heart failure + APO
Presentation
No typical presentation! -> 'Classic' triad = hypoxia, haemodynamic collapse, DIC
APO/ALI (>90%)
Cardiac arrest (>90%)
Fetal distress (100%)
SOB
Bronchospasm
Cough
Arrhythmia
Chest pain
Seizure
Headache
Uterine atony
Risk Factors
Age > 25 yrs
Multiparous
Obstructed labor with oxytocics
Short labour
Maternal history of allergy or atopy
Chorioamnionitis
Meconium liquor
Polyhydramnios
Placental abruption
Uterine rupture
Jeremy Fernando (2011)
IUFD
Diagnosis
- clinical grounds
- specific antigen testing of maternal bloods can help
- plasma concentration of zinc coproporphyrin (a component of meconium)
Management
Supportive!
Call for help - anaesthetic, obstetric, haematological, ICU, paediatric, midwifery
Goals:
(1) Prompt recognition
(2) Prompt resuscitation
(3) Early delivery of fetus
A - ETT (RSI)
B - FiO2 1.0 + PEEP
C - CPR + left uterine displacement, IVF, inotropes, PAC may be needed -> initially develop
right heart failure then this recovers and left heart begins to fail -> treat left sided heart
failure aggressively
Early delivery of fetus vital for both patients - if mum having CPR delivery within 5 min.
Manage coagulopathy
Oxytocics + bimannual massage & uterine packing +/- hysterectomy may be indicated.
ICU Admission
Notify Local Data Collection Agency
Jeremy Fernando (2011)