Transcript Amniotic fluid embolism “ Anaphlactoid Syndrome of pregnancy

Prof. Dr. Bahaa Ewiss
Professor of Ansthesia & Intensive Care Unit
Ain Shams university
Introduction
 Amniotic fluid embolism
is pure unpreventable,
unpredictable & incompletely understood syndrome
with potentially lethal complication ( mortality rate up
to 85%).
 So since it is rapid , progressive & with lethal
complication, so the diagnosis is very difficult & by
exclusion.
 It was 1st described by Brazilian medical journal in 1926 ,
then diagnosed in 1941 by finding fetal debris in maternal
lungs & Finally, in 1966,
fetal debris were found in
maternal lungs, kidneys, spleen.
The pulmonary
artery contains
layers of pink
strips of
squames,
derived from
the amniotic
fluid.
Pathophysiology
Amniotic fluid +
fetal debris
Genesis of the
syndrome
Utero placental
membrane leakage
Maternal
circulation
Leukotriens
&
PGs
Predisposing factors
 Age: > 35 years old
 Medical induction of labor
 Amniocentesis
 Instrumentation
 Artificial rupture of
 Multiparicicty





membrane
Cervical ulceration
C.S.
Eclampsia
Fetal macrosomia
Fetal distress
 Placenta previa
 Polyhydramnios
 Uterine rupture
Presentation
 In case of vaginal delivery or C.S. under spinal
anesthesia:
 Acute unexplained hypotension
 Desaturation , hypoxia , bronchospasm, ….
 In case of C.S. under G.A. :
 Unexplained hypotension, hypoxia , coagulopathy
Presentation cont….
 Cardiac presentation
Biphasic
Short & rapid
Right ventricular
failure
Long & slow
progressive
Left ventricular
failure
Pulmonary
hypertension
Hypotension
Pumonary
edema
Hypoxia
Mortality 50 %
Pumonary
congestion
Right ventricular
failure
Morbidity of the condition





DIC
Heart failure
Renal failure
Neurological ( convulsion)
Post arrest complications
Monitoring
 Basic:
 ECG
 NIBP
 SO2
 Capnography
 Advanced:
 T.E.E.
 Invasive blood pressure
 Pulmonary artery catheter
 CVP
Investigations “ non specific “
 CBC : there is a marked decrease in the platelet levels
 Fibrinogen: there is a decrease in the level
 FDPs: there is an significant increase in the level
 D.dimer : ????
Management
 Delivery may increase the survival of both the baby &
his mother
Management cont…..
According to CPR guideline of pregnant
women
Oxygenation
E.T.T
Mechanical
ventialtion
Management cont…..
Cardio vascular
management
If the patient arrests
CPR must be started
Supportive
therapy
(according to the
international guidelines)
Vasopressor
Adequate
Oxygenation and
early intubation
should be
considered
Nor adrenaline,
dopamine ,
dobutamine
Other line of management
 Haemofiltration
 Plasma exchange
 ECMO
 Cell salvage
 Management of DIC
 Ventilator assisted devices
Frequently asked questions
Q1 :What about the role of heparin
single dose??
Q2: What about corticosteroid IV??
Conclusion
 As it is rapid , progressive with lethal complications so we
should be minded about amniotic fluid embolism & rapid
interference.
 Good monitoring of the patient during labor , C.S. or in the
recovery is mandatory.
 Amniotic fluid embolism should be considered in case of rapid
progressive hypotension, desaturation & hypoxia.
 Rapid delivery of the baby.
 CPR as soon as possible.