Write in detail about Amniotic fluid Embolism

Amniotic fluid Embolism is a rare but potentially catastrophic condition that occurs when Amniotic fluid enters the maternal circulation via the uterus or placental site.The body responds in two phases.

The initial phase is pulmonary vaso spasm causing hypoxia, hypertension and cardio vascular collapse .

The second phase is the development of LVF with haemorrhage and coagulation disorders which is followed by pulmonary edema.

Timing of occurs:

Amniotic fluid embolism is a following procedure such as artificial rupture of membrane and insertion of intrauterine catheter.
In labor, after spontaneous rupture of membrane associated with strong uterine contraction or hypertonic contraction.
Amniotic fluid Embolism may occur during perforated or ruptured uterus.
Trauma during intra uterine manipulation such as internal podalic version.
During caesarean section.

Clinical signs and symptoms :

Generalized pruritics, bronchospasm , hypotension and tachycardia occuring within few minutes may be seen .
Sudden onset of maternal respiratory distress, cyanosis and retrosternal pain may be seen during amniotic fluid Embolism.
Foetal distress in response to uterine hypoxia may cause in Amniotic fluid Embolism.
Cardio pulmonary arrest follows quickly in a few minutes.
Convulsions may be seen followed by acute collapse and shock.
Blood coagulopathy following the initial collapse .
Death within one hour occurs in about 50% .

Diagnosis:

Amniotic fluid Embolism should be considered in all cases of unexplained collapse.
Clinical picture is clearly described in amniotic fluid Embolism.
Blood coagulation studies may be seen.
Post mortem

Treatment:

Immediate resuscitation consisting of :

Oxygen and ventilation.
Hydrocortisone in large doses.
Aminophylline intravenously for respiratory distress.
Correction of blood loss and coagulation effects of indication.

Prognosis:

Mortality rate is very high about more than 50% within one hour from onset.

Mother who survives are likely to suffer a degree if neurological impairment.

Complications:

Disseminated intra vascular coagulation may occur.

Acute renal failure may be seen

Fetal demise may be occurred.