Afe Presentation

AMNIOTIC FLUID EMBOLISM
Keys:
 Introduction
 Definition
 Incidence/Epidemiology
 Causes
 Signs and symptoms
 Diagnosis
 Nursing management
 Complication
 Prevention
 Treatment
INTRODUCTION:
Amniotic Fluid Embolism AFE is also known as Anaphylactoid Syndrome of

Pregnancy.Amniotic fluid embolism (AFE) is a rare and life-threatening
complication that occurs when a pregnant woman gets amniotic fluid into her
bloodstream just before, during or immediately after childbirth.An amniotic fluid
embolism can lead to heart and lung failure, which causes several complications
due to a lack of oxygenated blood in your body. This could include cardiac arrest
(your heart stops beating). People with AFE may also bleed uncontrollably from
their uterus or C-section incision. AFE happens suddenly and is unpredictable. It’s
extremely challenging to treat and requires emergency medical care.
DEFINITION:
AFE is one of the catastrophic complications of pregnancy in which amniotic

fluid,fetal cells,hair or other debris enters into maternal circulation causing a
serious trigger of reaction resulting in cardiac, pulmonary and vascular collapse.
INCIDENCE:
1
As it is a very rare obstetric emergency,it occurs in 2-6 per 100,000 births i.e 1 per
20,000 birth,it's also comprises 10% of all maternal deaths.
CAUSES
What increases your risk of amniotic fluid embolism?
Risk factors for AFE are hard to predict because it’s rare and hard to study.
However, current research points to a few possible risk factors, including:
Advanced maternal age (being older than 35 during pregnancy).
Expecting multiples (twins, triplets or more).
Fetal distress (changes to the fetal heart rate).
Issues with the placenta like placental abruption.
Preeclampsia or eclampsia.
Polyhydramnios (too much amniotic fluid).
Cervical tears.
Labor induction medications or procedures.
Having a C-section delivery.
Operative assisted deliveries (forceps delivery or vacuum extraction).
SIGNS AND SYMPTOMS:
What are symptoms of amniotic fluid embolism?
Signs and symptoms of AFE develop suddenly and quickly. They’re similar to
symptoms of other complications during pregnancy and childbirth, making the
condition more challenging to detect. Possible symptoms include:
Shortness of breath or difficulty breathing.
Sudden drop in blood pressure.
2
Pulmonary edema (fluid in your lungs).
Abnormal heart rate.
Bleeding from your uterus, C-section incision or IV (intravenous) sites.
Fetal distress.
Agitation, confusion or sudden anxiety.
Chills.
DIAGNOSIS:
Diagnosing AFE is after all other causes have been excluded.It is based on signs
and symptoms observed during and after the birth process,and a confirmation is
ONLY AFTER THE EVENT when the presence of squamous cells or other tissues
including meconium is found in mother's circulation.
NURSING MANAGEMENT
Admit the patient with amniotic fluid embolism (AFE) into the intensive care unit
(ICU).
Treatment is supportive and includes the following:
Administer oxygen to maintain normal saturation. Intubate if necessary.
Initiate cardiopulmonary resuscitation (CPR) if the patient arrests. If she does not
respond to resuscitation, perform a perimortem cesarean delivery.
Treat hypotension with crystalloid and blood products. Use pressors as necessary.
Avoid excessive fluid administration. During the initial phase, right ventricular
function is suboptimal. Excess fluid may overdistend the Right ventricle which
could increase the risk of a right sided myocardial infarction.
Consider pulmonary artery catheterization in patients who are hemodynamically

unstable.
3
Continuously monitor the fetus. Deliver immediately by the safest and quickest
means following cardiac arrest if gestational age is ≥ 23 weeks.
Early evaluation of clotting status (bedside clothing time ) and early initiation of
massive transfusion protocols is recommended.
Treat coagulopathy with FFP for a prolonged a PTT, cryoprecipitate for a

fibrinogen level less than 100 mg/dL, and transfuse platelets for platelet counts
less than 20,000/µL.
TRANSFER
Transfer to a level 3 hospital may be required once the patient is stable.
SURGICAL CARE
Perform emergent cesarean delivery in arrested mothers who are unresponsive

to resuscitation.
Control hemorrhage with bilateral uterine artery embolization. bleeding should

be arrested with the procedure and increase chances of patients survival.
COMPLICATIONS
What are the complications of amniotic fluid embolism?
AFE can cause serious complications for you and the fetus. For you, these include:
Heart and lung failure.
Losing consciousness.
Seizures.
Excessive bleeding.
Disseminated intravascular coagulation (DIC), a type of blood clotting issue.
Stroke.
Cardiac arrest (when the heart stops beating).
4
Brain damage.
Death.
The fetus is at risk of complications depending on when an amniotic fluid

embolism occurs. An emergency delivery may be necessary if symptoms begin
before the fetus is born. Babies who are delivered once AFE has already begun are
at risk for not getting enough oxygen. Lack of oxygen could cause impairments in
their nervous system or brain
LONG TERM COMPLICATIONS FOR PEOPLE WHO SURVIVE?
It depends on how severely the patient react to AFE as well as health history.
There can be both physical and psychological side effects from amniotic fluid
embolism. Some long-term effects could include:
Neurological damage that affects memory or word recall.
Permanent heart damage.
Complications from stroke (if there is stroke).
Kidney problems.
Anxiety, depression and feelings of guilt.
Post-traumatic stress disorder (PTSD).
PREVENTION
How can I prevent amniotic fluid embolism?
Unfortunately, there’s no way to prevent amniotic fluid embolism. Healthcare

providers are still unsure why AFE happens and what exactly causes this
condition. One way to prepare for any kind of medical emergency is to develop a
plan with your family and healthcare providers. Ask your healthcare provider
about emergency situations and how your medical team approaches these
situations.
5
This may be a part of your birth plan (a document you develop before giving birth
with your wishes for the birth). Remember, your birth plan represents the ideal
situation. If there is ever an emergency, your healthcare team will need to act
accordingly to protect the health of you and the fetus.
Treatment:
A Journal in 2020 has revealed that when Milrinone is administered as an

aerosol,selective pulmonary vasolidation occurs without significant changes in
mean arterial pressure or systemic vascular resistance,but if used immediately
after AFE,inhaled Milrinone may mitigate the pulmonary vasoconstriction thereby
providing a bridge to extracorporeal membrane oxygenation.
Milrinone is a pulmonary vasolidator used in the management of emergent right

ventricular failure.
Milrinone can be infused but as it's target is to resolve pulmonary

vasoconstriction,it is best inhaled via a nebulizer for immediate effect.

Afe Presentation

Uploaded by

Copyright:

Available Formats

Afe Presentation

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Afe Presentation

Uploaded by

Copyright:

Available Formats

AMNIOTIC FLUID EMBOLISM

Amniotic Fluid Embolism AFE is also known as Anaphylactoid Syndrome of

AFE is one of the catastrophic complications of pregnancy in which amniotic

What increases your risk of amniotic fluid embolism?

Advanced maternal age (being older than 35 during pregnancy).

Expecting multiples (twins, triplets or more).

Fetal distress (changes to the fetal heart rate).

Issues with the placenta like placental abruption.

Polyhydramnios (too much amniotic fluid).

Labor induction medications or procedures.

Having a C-section delivery.

Operative assisted deliveries (forceps delivery or vacuum extraction).

SIGNS AND SYMPTOMS:

What are symptoms of amniotic fluid embolism?

Shortness of breath or difficulty breathing.

Sudden drop in blood pressure.

Abnormal heart rate.

Bleeding from your uterus, C-section incision or IV (intravenous) sites.

Agitation, confusion or sudden anxiety.

Treatment is supportive and includes the following:

Administer oxygen to maintain normal saturation. Intubate if necessary.

Consider pulmonary artery catheterization in patients who are hemodynamically

Treat coagulopathy with FFP for a prolonged a PTT, cryoprecipitate for a

Transfer to a level 3 hospital may be required once the patient is stable.

Perform emergent cesarean delivery in arrested mothers who are unresponsive

Control hemorrhage with bilateral uterine artery embolization. bleeding should

What are the complications of amniotic fluid embolism?

Heart and lung failure.

Disseminated intravascular coagulation (DIC), a type of blood clotting issue.

Cardiac arrest (when the heart stops beating).

The fetus is at risk of complications depending on when an amniotic fluid

LONG TERM COMPLICATIONS FOR PEOPLE WHO SURVIVE?

Neurological damage that affects memory or word recall.

Permanent heart damage.

Complications from stroke (if there is stroke).

Anxiety, depression and feelings of guilt.

Post-traumatic stress disorder (PTSD).

How can I prevent amniotic fluid embolism?

Unfortunately, there’s no way to prevent amniotic fluid embolism. Healthcare

A Journal in 2020 has revealed that when Milrinone is administered as an

Milrinone is a pulmonary vasolidator used in the management of emergent right

Milrinone can be infused but as it's target is to resolve pulmonary

You might also like