Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 13 , ISSUE 3 ( September, 2009 ) > List of Articles

REVIEW ARTICLE

Amniotic fluid embolism

A. Rudra, S. Chatterjee, S. Sengupta, B. Nandi, J. Mitra

Keywords : Amniotic fluid embolism, coagulopathy, hypoxia

Citation Information : Rudra A, Chatterjee S, Sengupta S, Nandi B, Mitra J. Amniotic fluid embolism. Indian J Crit Care Med 2009; 13 (3):129-135.

DOI: 10.4103/0972-5229.58537

License: CC BY-ND 3.0

Published Online: 01-09-2009

Copyright Statement:  Copyright © 2009; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The disastrous entry of amniotic fluid into the maternal circulation leads to dramatic sequelae of clinical events, characteristically referred to as Amniotic fluid embolism (AFE). The underlying mechanism for AFE is still poorly understood. Unfortunately, this situation has very grave maternal and fetal consequences. AFE can occur during labor, caesarean section, dilatation and evacuation or in the immediate postpartum period. The pathophysiology is believed to be immune mediated which affects the respiratory, cardiovascular, neurological and hematological systems. Undetected and untreated it culminates into fulminant pulmonary edema, intractable convulsions, disseminated intravascular coagulation (DIC), malignant arrhythmias and cardiac arrest. Definite diagnosis can be confirmed by identification of lanugo, fetal hair and fetal squamous cells (squames) in blood aspirated from the right ventricle. Usually the diagnosis is made clinically and by exclusion of other causes. The cornerstone of management is a multidisciplinary approach with supportive treatment of failing organs systems. Despite improved modalities for diagnosing AFE, and better intensive care support facilities, the mortality is still high.


PDF Share
  1. Embolia pulmonar amnio-caseosa. Braz Med 1926;2:301-3.
  2. Amniotic fluid amnio as possible factor in etiology of eclampsia. Am J Obstet Gynecol 1927;14:292-300.
  3. Maternal pulmonary embolism by fluid as a cause of obstetric shock and unexpected deaths in obstetrics. JAMA 1941;117:1245-54.
  4. Amniotic fluid embolism: Analysis of the national registry. Am J Obstet Gynecol 1995;172:1158-67.
  5. Acute hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goat model. Am J Obstet Gynecol 1993;168:1113-30.
  6. United kingdom amniotic fluid embolism register. BJ0G 2005;112:1625-9.
  7. Amniotic fluid embolism. Anesthesia 1979;30:20-6.
  8. Amniotic fluid embolism. Obstet and Gynecol Cl N Am 1999;26:435-44.
  9. Amniotic fluid embolism: An update. Contemporary OB/GYN 2000;45:53-62.
  10. New concepts of amniotic fluid embolism: A review. Obstet Gynecol Surv 1990;45:360-8.
  11. The release of thromboxane A2 and prostacyclin following experimental acute pulmonary embolism. Prostaglandins Leukot Med 1983;11:1-10.
  12. Amniotic fluid activates complement: A role in amniotic fluid embolism syndrome? J Lab Clin Med 1984;104:901-7.
  13. Amniotic fluid embolism and leukotrines. Am J Obstet Gynecol 1986;155:1119-24.
  14. Endothelin has a role in early pathogenesis of amniotic fluid embolism. Gynecol Obstet Invest 1995;40:14-8.
  15. Immuno histochemical identification of syncytiotrophoblastic cells and megakaryocytes in pulmonary vessels in a fatal case of amniotic fluid embolism. Int J Legal Med 1996;108:210-4.
  16. The diagnosis of amniotic fluid embolism: An immunohistochemical study for the quantification of pulmonary mast cell tryptase. Int. Legal Med 1998;111:238-43.
  17. Amniotic fluid embolism after transabdominal amniocentesis. Eur J Obstet Gynecol Reprod Biol 1983;16:25-30.
  18. Amniotic fluid embolish with second trimester pregnancy termination: A case report. Can J Anesth 2004;51:139-44.
  19. Amniotic fluid embolism as a cause of death in a car accident: A case report. Forensic Sci Int 2003;137:231-4.
  20. Amniotic fluid embolism after saline amnioinfusion: Two cases and a review of the literature. Obstet Gynecol 1994;83:851-4.
  21. Amniotic fluid embolism in progress: A management dilemma. Am J Perinatol 1998;15:491-3.
  22. Landmark perspective: Amniotic embolism. To understand an enigma. JAMA 1986;255:2183-6.
  23. Acute respiratory failure in pregnancy. An analysis of 19 cases. Medicine 1998;77:41-9.
  24. Amniotic fluid embolism: Emergency management. J Accid Emerg Med 1996;13:285-6.
  25. Squamous cell in the maternal pulmonary circulation. Am J Obstet Gynecol 1986;154:104-6.
  26. The cytologic diagnosis of amniotic fluid embolism: A critical reappraisal. Diagn Cytopathol 1987;3:126-8.
  27. Squamous and trophoblastic cell in the maternal pulmonary circulation identified by invasive hemodynamic monitoring during the peripartum period. Am J Obstet Gynecol 1986;155:999-1001.
  28. Pulmonary microvascular cytology. A new diagnostic application of the pulmonary artery catheter. Chest 1985;88:908-14.
  29. Serological and immunohistochemical diagnosis of amniotic fluid embolism. Semin Thromb Hemost 1998;24:479-84.
  30. Determining zinc coproporphyrin in maternal plasma-A new method for diagonising amniotic fluid embolism. Clin Chem 1992;38:526-9.
  31. Amniotic fluid embolism. Seminars in Anesthesia, Perioperative Medicine and Pain 2000;19:181-7.
  32. Embolic events in pregnancy. In: Anesthetic and obstetric management of high risk pregnancy. 2 nd ed. Datta S, editor. St. Louis: Mosby -Yearbook, Inc; 1996. pp. 443-63.
  33. Amniotic fluid embolism. Crit Care Med 2005;33: S279-5.
  34. Massive amniotic fluid embolism: Diagnosis aided by emergency transesophageal echo cardiography. Int J Obstet Anesth 2004;13:279-83.
  35. Successful application of extracorporeal membrane oxygenation and intraaortic balloon counter pulsation of amniotic fluid embolism. Am J Obstet Gynecol 2000;183:496-7.
  36. Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: Diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass. Obstet Gynecaol 2003;102:496-8.
  37. Amniotic fluid embolism and isolated coagulopathy: Atypical presentation of amniotic fluid embolism. Eur J Anaesthesiol 2001;18:410-3.
  38. Continuous hemofiltration for disseminated intravascular coagulation and shock due to amniotic fluid embolism: Report of a dramatic response. Intern Med 2001;40:945-7.
  39. Two cases of hemorrhage secondary to amniotic fluid embolism managed with uterine artery embolization. Can J Anesth 2004;50:917-21.
  40. Amniotic fluid removal during cell salvage in the cesarean section patient. Anesthesiology 2000;92:1531-6.
  41. Amniotic fluid embolism: A review of the literature. Can J Anesth 2001;48:88-98.
  42. Amniotic fluid embolism. Kuwait Med J 2003;35:91-7.
  43. Pregnancy and complications of Pregnancy. In: Anesthesia and uncommon diseases. 5 th ed. Fleisher  LA, editor. Philadelphia: Saunders, Elsevier; 2006. p. 557-61.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.