Amniotic Fluid Embolism (AFE) is a rare and incompletely understood type of obstetric emergency. In this obstetrical complication, amniotic fluid, hair, fetal cells, or other debris enters the blood stream of the mother via the placental bed of the uterus and activates an allergic reaction. This allergic reaction then leads to cardiorespiratory (heart and lungs) collapse of the mother and coagulopathy. Amniotic fluid embolism was first formally characterized in 1941. This pregnancy problem ranks as #5 on the list of causes of maternal mortality.
Causes of Amniotic Fluid Embolism (AFE)
Mostly, it is agreed that this obstetric emergency condition is because of the entry of the amniotic fluid in the uterine veins, and there are three prerequisites for this condition to occur. These three prerequisites are: a pressure gradient from the uterus to vein, ruptured cervical or uterine veins, and ruptures amniotic sac membranes. Even if exposure to fetal tissue is quite common and detecting fetal tissue within the maternal circulation is not so significant, still in a small percentage of women this very exposure can lead to a complex chain of events that eventually result in collapse and even death. There are some evidences stating that Amniotic Fluid Embolism can be related with abdominal trauma.
Phases in Amniotic Fluid Embolism
This condition is so rare that most doctors and gynecologists do not get the opportunity to encounter it in their medical careers, and so the exact process of this problem remains poorly understood. However, it is considered that once the entry of the fluid and fetal cells takes place in the maternal pulmonary circulation, a two-phase process happens:
First Phase: The patient of Amniotic Fluid Embolism suffers from acute shortness of breath paired with hypotension. This state rapidly progresses leading to cardiac arrest since the heart chambers fail to dilate and there is a reduction in the level of oxygen to the lungs and the hearts.
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Not long after this phase, the patient will pass into coma. 50% of patients in this case die within the first hour of symptoms.
Second Phase: Though many patients fail to survive beyond the first stage of Amniotic Fluid Embolism, around 40% of the initial survivors pass onto the second phase. This phase is known as the hemorrhagic stage and can be followed by severe coughing, shivering, sensation of a bad taste in the mouth, vomiting, and excessive bleeding as blood loses the capability of clotting. Cardiovascular collapse progresses to fetal distress and death until the child is swiftly delivered.
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