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:
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Age Factor - If the mother is above 35 years, there is an advanced risk of amniotic fluid embolism.
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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.
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Polyhydramnios - This is a condition with too much amniotic fluid around the baby, which is also considered a risk factor for mothers.
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Medically Induced Labor - In some cases, medically induced labor can serve as a risk factor for amniotic fluid embolism.
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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.
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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.
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Cervical tear or lacerations.
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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,
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Sudden shortness of breath.
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Low blood pressure.
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Chills.
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Altered mental status.
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Nausea and vomiting.
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Loss of consciousness.
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Discoloration of the skin.
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Pulmonary edema (collection of fluid in lungs).
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Cardiovascular collapse (sudden failure of the heart to pump blood effectively).
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Bleeding from the uterus.
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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:
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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).
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Complete blood and coagulation (the process by which blood clot is formed) study to detect early clotting of blood.
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Blood type and screening tests are helpful during transfusion.
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Chest radiographs help detect acute pulmonary edema (fluid accumulation in the lungs).
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An electrocardiogram (ECG) helps to detect heart failure.
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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:
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Oxygen administration using a tracheal tube or mechanical ventilation.
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Blood, plasma, and platelet transfusions.
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Hysterectomy to stop the bleeding (if it is the source of bleeding).
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Urgent delivery.
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Cardiac catheterization (a thin, flexible tube attached to the heart's blood vessels for problems like blood clots and irregular heartbeat).
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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:
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Brain injury or Memory Loss - Less oxygen supply to blood can cause permanent damage to the brain.
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Organ failure.
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Short-term or permanent heart damage.
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Damage to the pituitary gland.
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Complete or partial removal of the uterus.
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Infant death.
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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.