Amniotic fluid embolism (AFE) isn’t a term you’d hear at all throughout the course of pregnancy because it’s extremely rare – it refers to an extremely dangerous condition that is likely to occur during or immediately after the delivery of the baby. What is it, what are the causes and symptoms, and what kind of treatment is available?
What is amniotic fluid embolism?
Embolism means “the sudden obstruction of a blood vessel by an embolus – an abnormal particle circulating in the blood”. Amniotic fluid embolism thus refers to the obstruction of a blood vessel by amniotic fluid – the abnormal particle – in the mother’s bloodstream.
Amniotic fluid contains the fetus’ vellus (hair that grows all over the body), the fetus’ hair, skin cell, feces, and urine. The amniotic fluid, upon entering the mother’s bloodstream, can cause respiratory failure, or can cause an anaphylactic shock (a severe allergic response).
Symptoms of amniotic fluid embolism
According to the AFE Foundation, the estimated incidence rate is about 2.5 in every 100,000 births or 1 in 40,000 deliveries in North America, and 1 in 53,800 deliveries in Europe.1Data on AFE in other countries have yet to materialize as AFE remains relatively unknown.
The symptoms of the first phase of AFE are as follows: a sudden drop in blood pressure, chest pain, vomiting, convulsions, breathing difficulties, cyanosis (skin discoloration), and cardiac arrest. The second phase is characterized by disseminated intravascular coagulation (DIC, the blood becomes unable to clot and thus doesn’t stop flowing), and the mother might also lose a large amount of blood.
The symptoms appear within a short time frame once AFE happens, so there isn’t sufficient time for doctors to respond. Although there are cases of the mother being saved, they might suffer from long-term organ failure or a range of neurological injuries that could cause memory loss.
Diagnosis and treatment of amniotic fluid embolism
Tests can show if there is fetal material such as meconium or urine in the mother’s blood. Although the test is able to produce results promptly after the amniotic fluid enters the mother’s bloodstream, they are most often used to confirm the cause of the mother’s death.
Treatment of AFE is actually the management of the symptoms and to try to restore the body to prior conditions. The mother might be oxygenated or connected to a ventilator to help with breathing, while through the regulation of breathing, doctors will try to bring blood pressure down. In most cases, blood transfusion is required.
The baby will be delivered after the mother’s condition has stabilized, and after delivery, the newborn infant will be checked into the Neonatal Intensive Care Unit (NICU) for further observation.
Effects of AFE on the mother and baby
Although amniotic fluid embolism is very rare, it can be fatal because the mother goes into cardiac arrest, dies from the profuse bleeding or is unable to recover from organ failure.
Research has shown that AFE is one of the leading causes of maternal deaths in Australia, Japan, the United States, the United Kingdom, France and Poland. The fatality rate is said to be around 40%2and most patients die within the first hour of the onset of symptoms. AFE can happen during or right after the labor, and as the mother has to be saved first before the fetus can even have a chance at survival, the death rates of AFE infants aren’t low either.
What are the risk factors of AFE?
Amniotic fluid embolism can happen during a cesarean section, and a huge amount of blood is usually lost because of DIC. When it takes place during a vaginal delivery, labor-inducing drugs or forceps can be the cause of Amniotic fluid embolism. Other risk factors include being of age 35 and above, being a multipara, meconium staining of amniotic fluid, polyhydramnios, placental abruption, or having a predisposition to allergies.
Expand knowledge on amniotic fluid embolism
The nature of AFE catches everyone around off-guard, and as it’s not only difficult to treat AFE, treatment has to be by doctors with excellent skills. Also, there aren’t any prevention methods made known, and doctors aren’t always prepared to handle such a situation. Although this seems to be a rather bleak conclusion, there is no specific way of actually preventing it. Try not to let it weigh too heavily on your mind, and take it as a lesson to expand your knowledge on pregnancy.