Amniotic Fluid Embolism – a Worst-Case Scenario?

Amniotic fluid embolism is a complication during pregnancy or childbirth caused by the ingress of amniotic fluid into the mother’s blood flow.

If the pressure in the uterine cavity exceeds the pressure in the mother’s veins the amniotic fluid can easily ingress into the mother’s blood vessels. When the amniotic fluid gets into the blood flow the disseminated intravascular clotting syndrome develops. It is a blood clotting system disruption with a simultaneous occurrence of multiple intravascular clots and hemorrhages.

In most cases, amniotic fluid embolism complicates the course of the first or second labor stage, but it also can happen during pregnancy (the second and third trimesters) or immediately after childbirth. Moreover, this complication often occurs during the second pregnancy and is life-threatening for the mother and the fetus.

Amniotic Fluid Embolism Survival Rate

Unfortunately, in 40-80% of the cases, amniotic fluid embolism is lethal for a mother. Infant or fetal death is the outcome in 30-65% of AFE cases.

But do not lose hope! There are cases of amniotic fluid embolism when the mother survives and even gives birth to a healthy baby. Well, the world is going on, and medical science does not stand still as well.

Amniotic Fluid Embolism Symptoms:

• Pale skin, cold sweat
• Cold fit
• Coughing (at first without sputum, then with foamy sputum)
• Rapid, shallow breathing
• Pain behind the breastbone, in the upper abdomen, lower limbs, headache
• Strong sense of fear
• Cyanosis of the face skin, lips, or limbs
• Low arterial pressure, rapid and shallow pulse
• Seizures
• Loss of consciousness
• Massive bleedings (uterine, nasal, etc.)

Amniotic Fluid Embolism Causes

The main cause of amniotic fluid embolism development is the ingress of water into the mother’s blood flow. Note, that It happens because of the difference between the intrauterine pressure (high) and intravascular pressure (low).

What Leads to the Augmented Intrauterine Pressure?

• Polyhydramnios (excess amniotic fluid)
• Multifetal pregnancy (more than one fetus in the uterus)
• Pelvic presentation of the fetus (the presentation when the baby’s pelvis is close to the inner opening of the cervix)
• Large fetus (more than 9 pounds)

Labor Anomalies

• High intensity of labor (strong, rapid contractions)
  • Discoordination of labor (strong contractions do not lead, however, to sufficient cervical dilatation and movement of the fetus through the maternal passages)
  • Irrational augmentation of labor (inadequate administration of uterotonics – the contractions stimulating drugs)
  • The rigidity of the cervix (the uterine cervix is tight and stiff)

The Amniotic Fluid Embolism Risk Factor Contributing To The Decline Of Intravascular Pressure Is Hypovolemia (Dehydration, Low Amount Of Fluid In The Bloodstream) Related To Such Diseases As:

• Heart diseases (valvular defects)
• Pancreatic diabetes (high blood sugar level because of the lack or irregular functioning of insulin – the hormone of the pancreatic gland)
• Gestosis (a complication of pregnancy that includes high arterial pressure and compromised kidney function)

The Ingress Of Amniotic Fluid Into The Mother’s Blood Flow Can Also Happen Because Of The Following Reasons:

• Untimely tearing of the fetal bladder (after cervical dilatation)
• Premature detachment of the placenta (the placenta separates from the uterine wall before delivery)
• Placental presentation (the placenta is positioned low in the uterine cavity and blocks the opening to the maternal passages)
• Tearing of the uterine wall
• Tearing of the uterine cervix
• C-section

Amniotic Fluid Embolism Treatment

Amniotic fluid embolism is a life-threatening complication of childbirth for the mother and the baby, it requires immediate treatment.

The Conservative Treatment Should be Aimed at

• Cardiovascular system recovery
• The arrest of bleeding with the help of fibrinolysis inhibitors (the drugs affecting the failure of natural dissolution of blood clotting)
• Elimination of the possibility of thrombosis
• Measures against the consequences of blood loss
• Augmentation of blood fluidity

Intensive Care in the Resuscitation Unit is Needed if the Pregnant Woman and the Fetus are in Grave Condition. If the Need Arises the Following Measures have to be Taken:

• Blood transfusion (when the blood loss is considerable)
• Mechanical ventilation of lungs (if the mother can not maintain respiratory function herself)

Early delivery by cesarean section or natural birth regardless of the term of pregnancy has to be performed immediately after the urgent measures in order to save the mother’s life.

Hysterectomy (removal of the uterus) is performed in the case of the failure of all the measures taken to cease uterine bleeding.

Complications and Consequences of the Amniotic Fluid Embolism

• Fetal death
• Kidney failure (acute insufficiency of the mother’s kidney functions leading to the cease of urinary excretion)
• Heart damage
• Stroke
• Pyoinflammatory complications during the postpartum period (endometritis – the inflammation of uterine lining)
• Psychological consequences (if the baby dies) – postpartum depression, PTSD
• Death of a mother

What can you do to Minimize the Risks?

• Pregnancy planning; detection and treatment of chronic and gynecological diseases; elimination of unwanted pregnancy
• Consultation with a doctor at the proper time (before the 12th week of pregnancy)
• Regular visits to an obstetrician-gynecologist (once a month during the first trimester; once every 2-3 weeks – during the second; once every7-10 days – during the third)
• Detection and treatment of pregnancy complications in time
• Dietary treatment (moderate in fat and carbohydrates: no fried food and sweets, and high in protein: meat, milk, and beans)
• Physical activity (exercises recommended for pregnant women – ask your doctor!)
• Elimination of stress, calm atmosphere in the family