Amniotic Fluid Embolism – Causes & Treatment

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A pregnant woman in pain

In the uterus, the baby is shielded by a protective fluid called the amniotic fluid. This not only acts as a cushion for the foetus but also helps transfer essential nutrients to it. However, if this fluid, along with any other foetal material leaks into the blood of the mother, it could cause serious complications like amniotic fluid embolism.

What is Amniotic Fluid Embolism?

An amniotic fluid embolism occurs as a result of the leak of amniotic fluid, foetal cells, or any other foetal material into the bloodstream of the mother. This generally takes place during the delivery or after the delivery. This condition calls for immediate medical care as it could lead to complications that may pose a threat to mother’s life.

Reasons of Amniotic Fluid Embolism

While the exact cause of AFE has not been determined yet, experts believe that the following can lead to it:

  • Ruptured membranes
  • A pressure gradient from the uterus to the maternal veins
  • Trauma to the abdomen during pregnancy
  • Ruptured veins in the uterus or cervix

Symptoms of AFE

The symptoms of amniotic fluid embolism are varied and they develop suddenly and rapidly. Some of the symptoms are as follows:

  • Pulmonary edema or accumulation of excess fluid in the lungs
  • Difficulty in breathing
  • Drop in blood pressure
  • The inability of the heart to pump blood suddenly (cardiovascular collapse)
  • Disseminated intravascular coagulopathy or problems with blood clotting
  • Chills
  • Seizures
  • Anxiety
  • Drop in the heart rate of the foetus or foetal distress
  • Spike in the heart rate of the mother
  • Coma
  • Excess bleeding from incisions, the uterus, and through IV sites

A pregnant woman suffering from nausea

Diagnosis

There are no diagnostic tests to confirm amniotic fluid embolism and the occurrence of the condition is determined on the basis of its symptoms.

Risk Factors

Although AFE is a rare occurrence, there are several factors that could increase the risk of AFE in women. Following are the factors that could lead to it:

  • If a woman is over 35 years
  • Abnormalities in the placenta including placenta previa and placental abruption
  • High blood pressure during gestation or preeclampsia
  • Excess protein in the urine post 20th week of pregnancy
  • Polyhydramnios or excessive amniotic fluid in the womb
  • C-section delivery, delivery using forceps, or vacuum extraction
  • Medically induced labour

Complications of AFE

The survival rate of women with amniotic fluid embolism is not very high. Reports state that only about 40 percent of the mothers survive this condition. According to the Journal of Anaesthesiology Clinical Pharmacology, around 30 percent of the babies do not survive AFE. As per the reports from the AFE Foundation, this number rises as high as 65 percent for the babies who are still in the womb.  But, the women and the babies who do survive this condition may face several complications.

Complications in mothers:

Following are the complications that a mother may face due to AFE:

  • Organ failure
  • Loss of memory
  • Temporary or permanent damage to the heart
  • A partial or complete hysterectomy where parts of the uterus will be removed
  • Damage to the pituitary gland

Complications in babies:

Even babies are not spared from this condition. AFE can result in following complications in babies:

  • Mild or severe impairment of the nervous system due to lack of oxygen to the brain
  • Cerebral palsy

Treatment of Amniotic Fluid Embolism

Treatment and management of amniotic fluid embolism is done with an immediate supply of oxygen. The patient may be put on a ventilator. Intravenous fluids are also provided and blood may be transferred. As there is a drop in blood pressure, certain medications to raise the blood pressure are administered. CPR will also be performed in the event of a cardiac arrest.

If the symptoms occur before the delivery of the baby, the baby will be delivered immediately and in case the mother makes it through, she will be placed on life support in an intensive care unit and monitored round the clock.

Coping and Support

Almost all to-be-moms wish to know if amniotic fluid embolism is common or not. The fact is that it isn’t very common and is known to occur in about 1 in every 21000 pregnant women. However, the set of complications it comes with make it very important to seek effective medical care and emotional support once a mother is discharged from the hospital.

Mothers affected by AFE will be emotionally overwhelmed and it is essential that they seek support from their partner or their family to get through this difficult time. It is also likely that they will need to be under the medical supervision of their OBGYN for a long time to recuperate from the condition. Regular medical visits to specialists may also be required based on the complications suffered.

An amniotic fluid embolism can be a difficult condition to deal with. Efficient monitoring by doctors during and before delivery may make it possible to identify the symptoms and receive timely treatment.

Also Read: Umbilical Cord Prolapse – An Overview