Three phases have been described during the clinical course of AFE. Labor abnormalities associated with an increased risk of AFE include precipitous labor, induction of labor, placental abruption, cervical laceration, and uterine rupture. Risk factors for AFE include advanced maternal age, multiparity, pre-eclampsia, eclampsia, diabetes mellitus, and polyhydramnios or other uterine over-distention. ![]() Patients may also present with acute severe consumptive coagulopathy without cardiorespiratory symptoms. AFE should be considered in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman. Although the pathophysiology of AFE is not known, it has been suggested that entry of amniotic fluid into the maternal circulation activates inflammatory mediators causing an anaphylactoid response.Īlthough AFE occurs most commonly during labor and delivery or the immediate postpartum period, it has been reported to occur as late as 48 hours postpartum. Neurologic impairment is also common in maternal survivors, particularly those who suffer associated cardiac arrest. Many surviving neonates suffer neurologic impairment. ![]() If AFE occurs prior to delivery, the neonatal mortality rate is estimated to be 10-50%. It is responsible for approximately 10-15% of maternal deaths in developed countries. The frequency of AFE is 2-7 cases per 100,000 births. All rights reserved.Amniotic Fluid Embolism (AFE) is an uncommon, catastrophic obstetric emergency. Excessive fluid administration should be avoided (GRADE 1C) and (7) because coagulopathy may follow cardiovascular collapse with amniotic fluid embolism, we recommend the early assessment of clotting status and early aggressive management of clinical bleeding with standard massive transfusion protocols (GRADE 1C).Īmniotic fluid embolism cardiorespiratory arrest pregnancy.Ĭopyright © 2016 Elsevier Inc. We recommend the following: (1) we recommend consideration of amniotic fluid embolism in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman (GRADE 1C) (2) we do not recommend the use of any specific diagnostic laboratory test to either confirm or refute the diagnosis of amniotic fluid embolism at the present time, amniotic fluid embolism remains a clinical diagnosis (GRADE 1C) (3) we recommend the provision of immediate high-quality cardiopulmonary resuscitation with standard basic cardiac life support and advanced cardiac life support protocols in patients who develop cardiac arrest associated with amniotic fluid embolism (GRADE 1C) (4) we recommend that a multidisciplinary team including anesthesia, respiratory therapy, critical care, and maternal-fetal medicine should be involved in the ongoing care of women with AFE (Best Practice) (5) following cardiac arrest with amniotic fluid embolism, we recommend immediate delivery in the presence of a fetus ≥23 weeks of gestation (GRADE 2C) (6) we recommend the provision of adequate oxygenation and ventilation and, when indicated by hemodynamic status, the use of vasopressors and inotropic agents in the initial management of amniotic fluid embolism. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used for defining the strength of recommendations and rating quality of the evidence. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. ![]() Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. The search was restricted to English-language articles published from 1966 through March 2015. We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism.Ī systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library.
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