19.9 Amniotic Fluid Embolism

An amniotic fluid embolism is a rare and potentially fatal condition that occurs when an opening develops between the amniotic sac and the client’s venous system during labor and delivery or within 30 minutes postpartum, allowing amniotic fluid and other fetal tissue to enter the maternal cardiovascular and respiratory systems. It appears to involve the initiation of a cytokine storm, as a result of exposure to an antigen in the amniotic fluid contents, resulting in abnormal activation of immunological processes similar to the systemic inflammatory response syndrome (SIRS).^[1]

Symptoms of an amniotic fluid embolism are abrupt and progressive and may include hypoxia, sudden and severe dyspnea, pulmonary edema, hypotension, cardiogenic shock, arrhythmias, seizures, and disseminated intravascular ϲοаgսlорathy (DΙС) with hemorrhage. Clients may experience a sense of sudden doom, chills, nausea and vomiting, agitation, anxiety, or change in mental status immediately preceding the event. Maternal cardiorespiratory complications and release of catecholamines cause increased uterine contractions and uterine tone, decreased uteroplacental perfusion, fetal hурохеmiа, and fetal acidosis. Rapid delivery of the fetus is often essential, but concurrent coagulopathy can result in significant maternal mortality. If a cesarean delivery must be urgently performed, blood, fresh frozen plasma (FFP), platelets, and cryoprecipitate should be available in the operating room for immediate administration on clinical evidence of impaired coagulation.^[2]

An amniotic fluid embolism is a medical emergency. Emergency treatment may include cardiopulmonary resuscitation (CPR), mass blood product transfusion, administration of tranexamic acid (TXA), hemodynamic support with intravenous administration of fluids and vasopressors, intubation, and mechanical ventilation.^[3]