Overview

• Amniotic fluid enters the maternal circulation and stimulates a severe systemic reaction → usually occurs around labour or delivery.
• Incidence is 2:100,000 (rare, however 5th leading cause of maternal death).
• Aetiology is unclear. Embolism provokes an anaphylactic reaction or complement cascade → pulmonary artery spasm → increases pulmonary artery pressure and RVP → hypoxic myocardial and pulmonary capillary damage → LVF and death.
• Risk Factors → increasing maternal age, placenta praevia, induction of labour (use of uterotonics), C-section.

Making Diagnosis

Clinical Features

• Symptoms → SOB, chest pain, chills, shivering, sweating, anxiety and coughing.
  • Bleeding → PPH due to resultant DIC.
• Signs → cyanosis, hypoxia, hypotension, tachypnoea, bronchospasms, tachycardia. arrhythmia and myocardial infarction.
• OCCURS DURING / SHORTLY AFTER LABOUR.

Investigations

• Clinical diagnosis of exclusion → no definitive diagnostic tests.
• ABG → hypoxaemia, raised PaCO2.

Management Plan

• Immediate → ABCDE (+ Call ITU Registrar)
  • Airway → maintain patency.
  • Breathing → high flow oxygen +/- intubation.
  • Circulation → 2 large bore cannulae + fluid resus. IV fluids to treat hypotension and blood transfusion in haemorrhage.
• Pharmacological → ionotropics.