Amniotic Fluid Embolism (Anaphylactic Syndrome of Pregnancy)

Overview

What is amniotic fluid embolism?

Amniotic fluid embolism is a very rare condition that can happen during childbirth or soon after birth. It’s unknown what causes amniotic fluid embolism, but some experts think it may be related to amniotic fluid entering the mother’s blood stream (circulatory system). Amniotic fluid is the liquid that the baby floats in while in the womb. When this fluid mixes with a mother’s blood, it can cause an allergic-like reaction that can be fatal. This is a medical emergency requiring expert medical care.

How common is amniotic fluid embolism?

This is a rare condition. It’s actually very difficult to identify an amniotic fluid embolism because the symptoms can be very similar to other complications like eclampsia, septic shock, placental abruption and uterine rupture. Because of this difficulty in the diagnosis process, it’s challenging to assign a percentage to how many women have amniotic fluid embolism each year.

Unfortunately, the death (mortality) rate for women who have this condition is high.

What are the risk factors for amniotic fluid embolism?

Researchers still aren’t sure why amniotic fluid embolism happens. However, current research points to a few possible risk factors for this condition, including:

  • Maternal age (a mother who gets pregnant at an older age).
  • Multiple gestation (one or more fetuses).
  • Fetal distress.
  • Placental abnormalities.
  • Eclampsia (seizures or convulsions).
  • Polyhydramnios (this occurs when there is too much amniotic fluid surrounding the baby).
  • Cervical lacerations (tear).
  • Uterine rupture.
  • Induction medications or procedures.
  • Cesarean section.
  • Operative assisted deliveries (forceps or vacuum).
  • Rapid and intense labor.

Diagnosis and Tests

How is amniotic fluid embolism diagnosed?

Diagnosing amniotic fluid embolism is difficult because many of the symptoms can overlap with other serious medical conditions. Your doctor will rule out other possible causes while working to diagnose amniotic fluid embolism. Amniotic fluid embolism is thought to occur in labor or within 30 minutes of delivery.

There are several signs and phases of amniotic fluid embolism. This condition occurs in two phases.

  • Phase one: During this phase, there’s rapid respiratory failure and cardiac arrest. This phase has the highest fatalities.
  • Phase two: This is the hemorrhagic (caused by a hemorrhage) phase. During this phase, you could experience excessive bleeding at the site of the Cesarean incision, or placental attachment.

Additional signs can include:

  • Acute low blood pressure (hypotension) or cardiac arrest.
  • Respiratory arrest and lack of oxygen.
  • Blood clotting or severe hemorrhage with no explanation. This can happen during labor, Cesarean birth (C-Section), dilation and evacuation within 30 minutes postpartum (after birth).

Management and Treatment

How is amniotic fluid embolism treated?

Treatment for amniotic fluid embolism will happen quickly and your doctor will

Amniotic fluid embolism is an emergency and treatment for this condition will need to happen very quickly to protect the life of both the mother and baby. Several methods the doctor may use can include:

  • Multiple blood, plasma and platelet transfusions.
  • Hysterectomy to stop the bleeding.
  • Steroids.
  • Urgent delivery.
  • Cardiopulmonary resuscitation.
  • Oxygenation by using tracheal tube or mechanical ventilation (supported breathing).

Prevention

Can I prevent amniotic fluid embolism?

Unfortunately, there is no way to prevent amniotic fluid embolism. Healthcare providers are still unsure why this 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. 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 your baby.

Last reviewed by a Cleveland Clinic medical professional on 11/12/2019.

References

  • National Organization for Rare Disorders. Amniotic Fluid Embolism. (https://rarediseases.org/rare-diseases/amniotic-fluid-embolism/) Accessed 11/19/2019.
  • Amniotic Fluid Embolism Foundation. What is amniotic fluid embolism? (https://www.afesupport.org/what-is-amniotic-fluid-embolism/) Accessed 11/19/2019.
  • Merck Manual Professional Version. Amniotic Fluid Embolism. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-complications-of-labor-and-delivery/amniotic-fluid-embolism) Accessed 11/19/2019.
  • Dobbenga-Rhodes YA. Responding to Amniotic Fluid Embolism. Association of Perioperative Nurses Journal. 2009; 98: 1079-1088
  • Avery, DM., MD. Obstetric Emergencies. (https://www.aapsus.org/wp-content/uploads/Obstetric-Emergencies.pdf) American Journal of Clinical Medicine. 2009; 6: 45-46. Accessed 11/19/2019.
  • Chamberlain G, Steer P. Obstetric emergencies. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115721/) BMJ. 1999 May 15; 318(7194): 1342-1345. Accessed 11/19/2019.

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