1. Amniotic Fluid Embolism
Women’s Hospital School of Medicine Zhejiang University
Wang Zhengping

2. Definition
Amniotic Fluid Embolism is a complex disorder during labor characterized by amniotic fluid entering into the maternal circulation which causes acute pulmonary embolism, shock, DIC, acute renal failure or abrupt death.

3. overview An devastating complication during labor
Mortality: up to 60%~80%
May occur in the first and second trimester abortions
Recently, it is also termed “anaphylactoid syndrome of pregnancy”

4. Why amniotic fluid can enter into the maternal circulation?

5. Etiology :Three factors
There is a breach in vein or blood sinus at the trauma site of cervix and the body of uterine
Higher pressure of amniotic cavity
Disruption of fetal membrane
amniotic fluid enters into the maternal circulation through the breached vein and blood sinus

6. What would happen
after the amniotic fluid enter into
the maternal circulation

7. pathophysiology Amniotic fluid→inferior vena → atrio dextro
→ right ventricle →pulmonary artery
Pulmonary artery hypertension
Allergic shock
DIC
Acute renal failure(ARF)

8. Clinical presentation
Acute amniotic fluid embolism: occur acutely
Pulmonary artery hypertension/ Shock
Hemorrhage due to DIC
Acute renal failure
Typical: three phages
Bulk colporrhagia
shock
Atypical:
(occur mainly after delivery)

9. Diagnosis
According to the typical clinic manifestation, we can make the preliminary diagnosis and save the patients immediately
While saving the patients do the necessary auxiliary examination, including:
a. Collecting blood from arteria pulmonalis and inferior
vena, and finding components of amniotic fluid
b. The basis of laboratory examination for DIC
c. ECG
d. X-ray
e. Autopsy

10. Basis of laboratory examination for DIC
PLT＜ 100 ╳109/L or it was gradually decrease
fibrinogen <1.5g/L
PT >15 s
plasm protamine paracoagulation test (+)
Obtrite RBC in blood smear

11. Management Improve hypoxia Anti-anaphylacic shock
Prevent DIC and acute renal failure(ARF)
Prevent infection

12. Treatment 1、Disengage pulmonary hypertension, improve hypoxia:
Oxygenation
Aminophylline
Narceine
Atropine
phentolamine
Anticonvulsive drug

13. Treatment 2、Anti-anaphylacic Glucocorticosteroid Hydrocortisone
Dexamethasone
Glucocorticosteroid

14. Treatment 3、Anti-shock Transfusion Angiotensin Treat heart failure
Cure acidemia

15. Treatment 4、Prevent and cure DIC
Use decoagulant and heparin as early as possible

16. 5、Prevent or cure ARF and infection
Treatment
5、Prevent or cure ARF and infection
Prevent ARF:
aware of urinary volume
Furosemide
Prevent infection
using antibiotic drug with low toxicity

17. Treatment 6、Obstetric management post partum intrapartum antepartum
amnionic fluid embolism
drug treatment
Cervical apertura is not open
or not fully open
Cervical apertura is fully dilatting
Without postpartum
hemorrhage
cesarean section delivery
Forcep delivery
Without hemorrage
postpartum hemorrhage
Go on the expectant treatment
Go on the expectant treatment
uterectomy

18. Prevention
Artificial rupture of membrane without stripping of membrane
Don’t conduct artificial rupture of membrane when uterine is constricting
Master the indication of oxytocin application
Protect the vessel during the caesarean section
Avoid precipitate labor, birth trauma, rupture of uterus, cervical laceration
Aware of the predisposing factor

19. Thanks