Know the basics
What is amniotic fluid embolism?
An amniotic fluid embolism, which was first formally characterized in 1941, is a rare childbirth (obstetric) emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother’s blood stream via the placental bed of the uterus and triggers an allergic-like reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and massive hemorrhaging (coagulopathy).
How common is amniotic fluid embolism?
This amniotic fluid embolism is quite rare and it occurs in 2-8 per 100,000 deliveries and is responsible for between 7.5% to 10% of maternal mortality. Amniotic fluid embolism only occurs in women. No racial or ethnic predilection has been thought to exist. However, a study by Fong et al suggested that non-Hispanic blacks have more than twice the risk of developing amniotic fluid embolism
However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of amniotic fluid embolism?
Amniotic fluid embolism develops suddenly and rapidly. The first stage of amniotic fluid embolism usually includes cardiac arrest and rapid respiratory failure. Cardiac arrest occurs when your heart stops working and you lose consciousness and stop breathing. Rapid respiratory failure occurs when your lungs cannot supply enough oxygen to your blood or remove enough carbon dioxide from it. This makes it very difficult to breathe.
Other possible signs and symptoms of amniotic fluid embolism might include:
- Sudden shortness of breath
- Excess fluid in the lungs (pulmonary edema)
- Sudden low blood pressure
- Sudden failure of the heart to effectively pump blood (cardiovascular collapse)
- Life-threatening problems with blood clotting (disseminated intravascular coagulopathy)
- Altered mental status, such as anxiety
- Rapid heart rate or disturbances in the rhythm of the heart rate
- Fetal distress, such as a slow heart rate
- Sudden fetal heart rate abnormalities
- Bleeding from the uterus, incision or intravenous sites
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes amniotic fluid embolism?
Amniotic fluid embolism occurs when amniotic fluid or fetal material enters the mother’s bloodstream. Why this happens is not well understood. A likely cause is a breakdown in the placental barrier, such as from trauma.
When this breakdown occurs, the immune system responds by releasing products that cause an inflammatory reaction, activating abnormal clotting in the mother’s lungs and blood vessels that can result in a serious blood-clotting disorder known as disseminated intravascular coagulation.
However, amniotic fluid embolisms are rare — and it’s likely that some amniotic fluid commonly enters the mother’s bloodstream during delivery without causing problems. It is not clear why in some cases this leads to amniotic fluid embolism.
Obviously, further research on what causes amniotic fluid embolisms is needed.
What increases my risk for amniotic fluid embolism?
Risk factors for this condition may include:
- Advanced maternal age: If you are 35 or older at the time of your child’s birth, you might be at increased risk of amniotic fluid embolism.
- Placenta problems: If there are abnormalities in your placenta — the structure that develops in your uterus during pregnancy — you might be at increased risk of amniotic fluid embolism. Abnormalities might include the placenta partially or totally covering the cervix (placenta previa) or the placenta peeling away from the inner wall of the uterus before delivery (placental abruption). These conditions can disrupt the physical barriers between you and your baby.
- Preeclampsia: If you have preeclampsia — high blood pressure and excess protein in the urine after 20 weeks of pregnancy — you might be at increased risk of developing amniotic fluid embolism.
- Medically induced labor: Limited research suggests that certain labor induction methods are associated with an increased risk of amniotic fluid embolism. Research on this link, however, is conflicting.
- Operative delivery: Having a C-section, a forceps delivery or a vacuum extraction might increase your risk of amniotic fluid embolism. These procedures can disrupt the physical barriers between you and your baby. It’s not clear, however, whether operative deliveries are true risk factors for amniotic fluid embolism or are used after the condition develops to ensure a rapid delivery.
- Polyhydramnios: Having too much amniotic fluid around your baby may put you at risk of amniotic fluid embolism.
Diagnosis & Treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is amniotic fluid embolism diagnosed?
Based on a doctor’s examination, the diagnosis of amniotic fluid embolism is determined. A diagnosis is typically made after other conditions have been ruled out. In some cases, a diagnosis is only made after maternal death. Some tests will be performed, include:
- Blood tests, including those that evaluate clotting, heart enzymes, electrolytes and blood type, as well as a complete blood count (CBC)
- Electrocardiogram (ECG or EKG) to evaluate your heart’s rhythm
- Pulse oximetry to check the amount of oxygen in your blood
- Chest X-ray to look for fluid around your heart
- Echocardiography to evaluate your heart’s function
How is amniotic fluid embolism treated?
Emergency treatments include:
- Catheter placement: Your health care team places a thin, hollow tube into one of your arteries (arterial catheter) to monitor your blood pressure. You will also have another tube placed into a vein in your chest (central venous catheter), which can be used to give fluids, medications or transfusions, as well as draw blood.
- Oxygen: You might need to have a breathing tube inserted into your airway to help you breathe.
- Medications: Your doctor might give you medications to improve and support your heart function. Other medications might be used to decrease the pressure caused by fluid going into your heart and lungs.
- Transfusions: If you have uncontrollable bleeding, you will need transfusions of blood, blood products and replacement fluids.
In case you have amniotic fluid embolism before delivering your baby, your doctor will treat you with the goal of safely delivering your baby as soon as possible. An emergency C-section might be needed.
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage amniotic fluid embolism?
Amniotic fluid embolism cannot be prevented, and doctors find it hard to predict if and when it will occur. If you have had amniotic fluid embolism and plan on trying to have another baby, talk to a high-risk obstetrician first. Your doctor will discuss the risks of pregnancy beforehand and watch you closely if you do become pregnant again.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: February 11, 2017 | Last Modified: February 20, 2017
Amniotic fluid embolism. http://www.mayoclinic.org/diseases-conditions/amniotic-fluid-embolism/basics/treatment/con-20035462 . Accessed 10 Feb, 2017.
Amniotic fluid embolism. http://www.healthline.com/health/pregnancy/amniotic-fluid-embolism#Overview1 . Accessed 10 Feb, 2017.
Amniotic fluid embolism. https://en.wikipedia.org/wiki/Amniotic_fluid_embolism . Accessed 10 Feb, 2017.