Amniotic Fluid Embolism: A Rare, Life-Threatening Pregnancy Complication

Amniotic fluid embolism (AFE) is a pregnancy-related pulmonary and neurologic complication, and a potentially life-threatening condition. Not only are there no known causes for the difficulty, nor can the risk of developing this complication be easily determined in advance, the condition itself is much unknown. However, it has been noted that women with previously ruptured membranes or who experience uterine rupture are at an increased risk of developing this complication.

It should be initially noted that this condition is very rare, occurring in one to 12 cases per 100,000 pregnancy deliveries or one in every 8,000, thus it can be considered as one less condition to worry about, as you move forward with your pregnancy, but knowledge is power and for some women, this diagnosis is a very real threat.

The complication of amniotic fluid embolism occurs either during second trimester dilatation, during labor or soon after delivery, and is thought to be the result of an allergic-like reaction to the amniotic fluid that enters the mother’s bloodstream; a normal part of the birth process.

This reaction is believed to be caused by the fetal contents, that were previously inside the uterus and managed in a sac inside the amniotic fluid, combining with a systemic reaction involving the release of cytokines and other chemical mediators.

Symptoms

Respiratory Distress

The most common symptoms of amniotic fluid embolism include respiratory distress, convulsions, chest pain, and coughing.

Pulmonary Hypertension

The complication has been found to cause elevated pulmonary pressure. This elevated blood pressure has been found to cause a rapid decline in lung function, thus leading to the aforementioned respiratory distress.

Changes in Mental Status

Changes in mental status have been associated with amniotic fluid embolism and specifically have included observed senses of doom and heightened anxiety levels.

Cessation of Heartbeat

The condition can cause a complete cessation of heartbeat. The person may suffer hypoxia, develop cyanosis, and other life-threatening complications.

Uterine Bleeding

Uterine bleeding is another symptom and can be heavy and cause shock on the body.

Additional signs of AFE include fetal distress, nausea or vomiting, chills, skin discoloration and abnormal vital signs.

Risks

Previous studies revealed mortality rates amongst women with AFE as high as 61 to 86 percent, however recent estimates suggest a lower fatality of 13 to 26 percent. According to researchers, this decrease in risk “may be the result of early diagnosis and better resuscitative care, as well as changes in case inclusion criteria.” Although maternal mortality rates have improved, fetal outcome remain poor if AFE occurs prior to delivery, with the neonatal mortality rate approximately more than 10 percent.

Amniotic fluid embolism has severe and complicated ripple effects when it occurs.

Ultimately, AFE is a life-threatening condition that can lead to death during pregnancy or after delivery and can increase the risk of premature labor, leading to premature birth and other complications that may risk the mother and baby’s life.

AFE can cause a severe cardiovascular shock. Occurrence of this can lead to further complications which may include pulmonary hypertension, pulmonary edema and respiratory distress. The shock may also cause a decrease in cerebral blood flow, which may lead to cerebral hypoxia and loss of consciousness.

Additional severe effects that can occur as a result include retinal detachment or ocular trauma, which causes blindness and damage to the retina. It may also cause organ damage and dysfunction as noted above, can impact the lungs, eyes, and brain.

How to Diagnose and Treat Amniotic Fluid Embolism

Diagnosing amniotic fluid embolism is difficult task as many of the symptoms can overlap with other serious medical concerns, however the symptoms typically occur in two phases; phase one consisting of respiratory failure and cardiac arrest, and phase two; a hemorrhagic phase in which excessive bleeding can occur.

If found to occur, AFE is an emergency treatment to save the life of mom and baby and several methods may be sued including blood, plasma and platelet transfusions, hysterectomy to stop excessive bleeding, steroid usage, urgent delivery, resuscitation and ventilation among others.

The person diagnosed with this complication may be required to undergo a comprehensive medical evaluation to determine the underlying conditions and associated complications. In most cases, the woman may develop pulmonary hypertension or acute respiratory distress syndrome before delivery. The evaluation may also rule out other conditions that can cause similar symptoms.

A woman diagnosed with this condition is usually given a cesarean section after detecting fetal distress. The complications associated with this pregnancy condition may be fatal, and they can even cause fetal death. In most cases, delivering the baby by cesarean section is considered a life-saving measure.

Oxygen therapy is used to help the person recover from life-threatening conditions such as pulmonary edema and treat the symptoms. Using oxygen may also protect the baby during delivery and increase blood flow to the lungs.

Fluid replacement is one of the most important treatments for this complication. The symptoms of pulmonary edema and other related difficulties may be eliminated with intravenous hydration to replace the lost fluids and electrolytes.

Amniotic fluid embolism is a life-threatening condition that can cause severe complications or even have a fatal impact to the mother and baby, however proper management of this complication in pregnancy may help prevent life-threatening complications and most women can find assurance knowing the rarity of these cases.