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Amniotic Fluid Embolism - Causes, Symptoms, Risk Factors, Complications, Diagnosis and Treatment

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Amniotic fluid embolism is an uncommon but a severe complication during pregnancy. This article explains the possible causes, symptoms, and treatment for amniotic fluid embolism.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Busi Maneesha

Published At June 1, 2022
Reviewed AtDecember 22, 2023

What Is Amniotic Fluid Embolism?

Amniotic fluid embolism, otherwise known as the anaphylactoid syndrome of pregnancy, is a rare and life-threatening condition that can occur during pregnancy or soon after birth. It happens when amniotic fluid (fluid surrounding the fetus), fetal cell, hair, or other debris move into the blood vessels. It affects both mother and baby.

How Prevalent Is Amniotic Fluid Embolism?

Amniotic fluid embolism is an uncommon condition; around one to twelve cases of amniotic fluid embolism are reported in 100,000 deliveries, so it is difficult to identify the risk factor. It can occur in healthy women during vaginal delivery, operative delivery, or abortion or after abnormal vaginal delivery. It can also happen within 48 hours post-delivery.

What Are the Risk Factors of Amniotic Fluid Embolism?

Here are some of the potential risk factors of amniotic fluid embolism:

  • Age Factor - If the mother is above 35 years, there is an advanced risk of amniotic fluid embolism.

  • Operative Delivery - Operative procedures like C-section, a forceps delivery, or a vacuum extraction might increase the risk of amniotic fluid embolism because the physical barriers between the mother and the baby are disrupted, which may cause amniotic fluid embolism.

  • Polyhydramnios - This is a condition with too much amniotic fluid around the baby, which is also considered a risk factor for mothers.

  • Medically Induced Labor - In some cases, medically induced labor can serve as a risk factor for amniotic fluid embolism.

  • Placental Problems - Deformities in the placenta (organ developing in the uterus during pregnancy) also increase the risk of amniotic fluid embolism. Anomalies like the placenta partially or fully covering the cervix (lower, narrow end of the uterus) and peeling away of the placenta from the uterus before delivery can damage the barrier between the mother and baby.

  • Preeclampsia - Preeclampsia is a condition that occurs after 20 weeks of pregnancy and is characterized by high blood pressure and damage to other internal organs, which may increase the risk of amniotic fluid embolism.

  • Cervical tear or lacerations.

  • Fetal distress.

What Are the Causes of Amniotic Fluid Embolism?

The exact cause of amniotic fluid embolism is still unclear and many theories have been put forward. Some say it occurs due to the entry of amniotic fluid into the mother's bloodstream because of the breakdown of the placenta. When this happens, there is an overreaction of the immune system, causing inflammation which activates clotting in the lungs and blood vessels, resulting in disseminated intravascular coagulation (blood clotting throughout the body). However, few researches show that many women do not have the same reaction, even when there is an entry of amniotic fluid into the bloodstream during delivery.

What Are the Symptoms of Amniotic Fluid Embolism?

Signs and symptoms of amniotic fluid embolism include,

  • Sudden shortness of breath.

  • Low blood pressure.

  • Chills.

  • Altered mental status.

  • Nausea and vomiting.

  • Loss of consciousness.

  • Discoloration of the skin.

  • Seizures.

  • Increased heart rate.

  • Pulmonary edema (collection of fluid in lungs).

  • Cardiovascular collapse (sudden failure of the heart to pump blood effectively).

  • Bleeding from the uterus.

  • Fetal distress (signs of changes in heart rate or decreased movement in the womb).

How Can We Prevent Amniotic Fluid Embolism?

Amniotic fluid embolism was found during the 1920s; since then, researchers have been puzzled about the exact cause and cannot predict who is at significant risk. This makes prevention a problematic task. If a mother has already experienced amniotic fluid embolism and is planning for the next child, it is advisable to consult a high-risk obstetrician first.

How to Diagnose Amniotic Fluid Embolism?

Amniotic fluid embolism diagnosis is difficult because the symptoms have similarities with other severe medical conditions. An amniotic fluid embolism occurs in several stages and phases, which include:

Phase One - It has the highest mortality rate because it is associated with rapid respiratory failure and cardiac arrest.

Phase Two - During this phase, there is increased hemorrhage (bleeding) at the cesarean incision or placental attachment site.

Traditionally amniotic fluid embolism is diagnosed during autopsy when fetal squamous cells are found in the maternal pulmonary circulation. Nowadays, doing a few tests help reduce the complications of an amniotic fluid embolism, which include:

  • Continuous oximetry (test to measure oxygen level) and arterial blood gas (test to measure oxygen and carbon dioxide level in blood) to determine the degree of hypoxia (low oxygen in the blood).

  • Complete blood and coagulation (the process by which blood clot is formed) study to detect early clotting of blood.

  • Blood type and screening tests are helpful during transfusion.

  • Chest radiographs help detect acute pulmonary edema (fluid accumulation in the lungs).

  • An electrocardiogram (ECG) helps to detect heart failure.

  • A lung scan is used to detect a blood clot in the lungs.

How Can Amniotic Fluid Embolism Be Treated?

If a physician suspects amniotic fluid embolism during pregnancy, immediate treatment should be started to prevent life-threatening complications. Several methods that doctors practice depending upon the situation are:

  • Cardiopulmonary resuscitation (CPR).

  • Oxygen administration using a tracheal tube or mechanical ventilation.

  • Blood, plasma, and platelet transfusions.

  • Hysterectomy to stop the bleeding (if it is the source of bleeding).

  • Urgent delivery.

  • Cardiac catheterization (a thin, flexible tube attached to the heart's blood vessels for problems like blood clots and irregular heartbeat).

  • Steroid administration.

Both mother and baby who survived amniotic fluid embolism may have long-term or lifelong medical issues like neurological disorders and permanent organ damage.

What Are the Complications Associated With Amniotic Fluid Embolism?

Statistics show that 80 percent of women do not survive amniotic fluid embolism. The remaining percentage of women who survive have to face many life-threatening complications after survival. The following are the long-term complications that can occur:

  • Brain injury or Memory Loss - Less oxygen supply to blood can cause permanent damage to the brain.

  • Organ failure.

  • Short-term or permanent heart damage.

  • Damage to the pituitary gland.

  • Complete or partial removal of the uterus.

  • Infant death.

  • Lengthy hospitalization.

Conclusion:

Amniotic fluid embolism is considered a rare but life-threatening condition during pregnancy. Even today, the actual cause of amniotic fluid embolism is unclear, so prevention is a challenging task. When doctors suspect amniotic fluid embolism during pregnancy, emergency treatment planning should be done for the survival of mother and baby.

Frequently Asked Questions

1.

Can Amniotic Fluid Embolism Be Prevented?

The fluid that surrounds the baby in the mother’s womb is referred to as amniotic fluid. Amniotic fluid embolism is a condition where the amniotic fluid enters the mother’s bloodstream. It results in severe signs and symptoms in the mother and requires immediate treatment. The following methods may aid in preventing amniotic fluid embolism:
- First, avoid placental incisions during C-sections.
- Avoid uterine trauma due to specific procedures like inserting a pressure catheter to measure the strength of uterine contractions.
- If a mother has a history of amniotic fluid embolism, then it is necessary to consult the specialist before planning for the next child.

2.

Is Amniotic Fluid Embolism Common?

Amniotic fluid embolism is an uncommon condition; studies show it accounts for one in 8000 to one in 80,000 childbirths. It may occur during delivery, a few hours after cesarean or vaginal delivery, and due to termination of pregnancy in the second trimester. Research shows the occurrence rate of amniotic fluid embolism as follows:
- 70 % during labor.
- 19 % during cesarean delivery.
- 11 % during vaginal delivery.

3.

What Are the Risk Factors for Amniotic Fluid Embolism?

Amniotic fluid embolism is a rare condition, but it may lead to severe complications. The factors that increase its risk are listed down:
- Mother’s age - Delivering a baby at or above the age of 35 may increase the risk.
- Pregnancy complication like preeclampsia causes high blood pressure and other internal organ damage in the mother.
- Placental abnormalities.
Increased amniotic fluid (polyhydramnios).
- Cesarean or other operative delivery.

4.

Which Fluid Is Used for Amnioinfusion?

Amnioinfusion refers to the replacement of amniotic fluid by the infusion of saline or lactated Ringer’s solution. It mainly contains sodium chloride, sodium lactate, potassium chloride, and calcium chloride. Lactated Ringer’s solution is primarily preferred as its composition and pH are closely similar to the amniotic fluid. In addition, it aids in managing oligohydramnios (low amniotic fluid level), and temporary fetal heart rate falls. Other indications for amnioinfusion include premature amniotic membrane rupture and reduction of the meconium aspiration during labor.

5.

Does AFE Occur During the C-Section?

An amniotic fluid embolism occurs uncommonly during labor or after cesarean section delivery. The exact cause is unknown, but studies show that the breakdown of the placenta may cause the entry of amniotic fluid into the mother’s bloodstream. The chances are high after a cesarean or forceps delivery. It causes severe complications in both mother and baby. Common signs are shortness of breath, chills, uterine bleeding, altered mental status, loss of consciousness, etc.

6.

How Is Amniotic Fluid Embolism Detected?

The doctor may find difficulties detecting amniotic fluid embolism (AFE) due to its similar features to other medical conditions. The methods involved in the diagnosis of AFE are:
- Electrocardiogram (ECG) to determine the heart rate.
- Pulse oximetry aids in evaluating the blood's oxygen level.
- Blood tests evaluate complete blood count (CBC), clotting, blood type, etc.
- Chest X-ray to detect the accumulation of fluid around the lungs and heart.

7.

Does Too Much Amniotic Fluid Cause Stillbirth?

The baby in the womb is surrounded by amniotic fluid, and its excessive accumulation is called polyhydramnios. The factors that may cause too much amniotic fluid are maternal diabetes, infection during pregnancy, congenital disabilities, fetal anemia, etc. The mild increase in amniotic fluid level may get resolved. However, too much amniotic fluid may result in several complications like preterm birth and stillbirth. About 4 in 1000 babies are stillborn due to polyhydramnios.

8.

Do High Levels of Amniotic Fluid Harm the Baby?

The high level of amniotic fluid is called polyhydramnios. A mild increase in amniotic fluid resolves on its own. Whereas the severe rise in amniotic fluid levels harms the baby in the womb and results in the following complications:
- Preterm labor.
- Premature birth.
- The baby’s bottom faces the cervix rather than the baby’s head.
- The umbilical cord may enter the vagina before the baby (umbilical cord prolapse).
- Excess fetal growth.

9.

Does Amniotic Fluid Embolism Happen Quickly?

Yes, amniotic fluid embolism occurs at the time or 30 minutes after delivery. It is a severe condition, and the following signs may happen:
- Phase 1 - Respiratory arrest, low blood pressure, and heart failure occur.
- Phase 2 - Excessive bleeding occurs at the incision site.
- It results in severe complications in both mother and baby.

10.

What Are the Effects on Babies From Mothers Who Died of an Amniotic Fluid Embolism?

Amniotic fluid embolism significantly impacts the survival rate of both mother and baby. Mostly, the mother may die due to severe respiratory arrest and cardiac failure. However, studies show that the fetal survival rate is 70 %. In addition, immediate resuscitation may improve the survival rate. Several neurological deficits may occur in babies from mothers who died of an amniotic fluid embolism. Fetal distress may also occur due to the prolonged labor process that results in permanent brain damage or cerebral palsy in infants.

11.

What Is the Nursing Priority in Amniotic Fluid Embolism?

Amniotic fluid embolism results in sudden and severe complications in both mother and fetus. Therefore, it requires immediate medical attention to improve the survival rate, and it includes:
- Oxygen supply through the face mask.
- Administer intravenous fluids.
- Monitor vital signs like blood pressure, heart rate, etc.
- Reduce the fetal delivery time.

12.

What Happens During Amniotic Fluid Embolism?

An amniotic fluid embolism occurs when the fluid surrounding the baby in the womb enters the mother’s bloodstream to cause severe inflammatory reactions. In addition, it may result in clotting in the mother’s blood vessels and lungs. The exact reason is unknown; however, the placental breakdown is the common cause. The affected mother experience the following signs and symptoms:
- Low blood pressure.
- Shortness of breath.
- Chills.
- Rapid heart rate.
- Loss of consciousness.
- Heart failure.
- Pulmonary edema.

13.

Is Amniotic Fluid Embolism Hereditary?

There are no reports to support that amniotic fluid embolism is hereditary. Instead, it is a sudden and severe complication due to several risk factors like advanced maternal age, placental abnormalities, forceps delivery, polyhydramnios, etc. It significantly affects the survival of both mother and baby. Therefore, it requires immediate resuscitation to prevent severe complications. A few research shows that certain genetic factors may lead to amniotic fluid embolism in women.

14.

Does Amniotic Fluid Cause Pulmonary Embolism?

As the amniotic fluid enters the mother’s bloodstream, it results in a sudden inflammatory reaction causing clotting of blood vessels and lungs. The clotting of blood vessels in the lungs is referred to as pulmonary embolism, which may occur due to amniotic fluid embolism. It results in severe constriction of the lung’s airway (bronchoconstriction), sudden shortness of breath, respiratory failure, and cardiac arrest. The fluid also accumulates around the lungs resulting in pulmonary edema.
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Dr. Busi Maneesha
Dr. Busi Maneesha

Obstetrics and Gynecology

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