Pathophysiology & Risk Factors

Amniotic fluid embolism occurs when amniotic fluid and fetal cells enter the maternal circulation and provoke a massive anaphylactoid reaction. Pulmonary vessels clamp down and the client becomes acutely hypoxic; the right heart then fails and blood pressure collapses; finally clotting factors are consumed and disseminated intravascular coagulation begins. It strikes during labor, at delivery, or within roughly thirty minutes afterward. Risk factors exist but predict almost nothing, so the condition is treated as unpredictable and unpreventable — recognition and speed are what the nurse contributes.

Signs & Symptoms

EarlyProgresses →

sudden dyspnea and gasping Hallmark

phase one is respiratory — it comes before anything else

sense of impending doom Hallmark

often the very first thing the client says

abrupt hypoxia and cyanosis

profound hypotension Hallmark

phase two — the right heart fails

seizure

abrupt fetal bradycardia

the fetus loses perfusion as the mother's pressure drops

Late / Severe

cardiac arrest

bleeding from IV sites and gums Hallmark

phase three — disseminated intravascular coagulation

uncontrolled uterine bleeding

Diagnostics & Labs

Diagnostic

clinical diagnosis of exclusion Hallmark

no test confirms it — treat while other causes are ruled out

type and crossmatch

Monitor

coagulation studies

a falling fibrinogen and platelet count confirm DIC

complete blood count

arterial blood gas

continuous pulse oximetry and cardiac monitoring

Interventions & Priorities

Sudden collapse in labor — first actions

Call the codeobstetric rapid response and anesthesia
Oxygen and airwayhypoxia is what kills first
CPR with uterine displacementpush the uterus off the vena cava
Massive transfusionDIC consumes clotting factors
Perimortem cesareanif there is no response to resuscitation

Treatments & Medications

oxygen and mechanical ventilation Hallmark

vasopressors

norepinephrine to support the collapsed blood pressure

cryoprecipitate and fresh frozen plasma Hallmark

replaces the fibrinogen and clotting factors DIC consumes

packed red blood cells

platelets

oxytocin for uterine atony

Patient Teaching

explain that nothing the client did caused this

keep the family informed during resuscitation

arrange debriefing and bereavement support

explain that recurrence in a later pregnancy is not expected

Complications

maternal cardiac arrest and death Hallmark

disseminated intravascular coagulation Hallmark

hypoxic brain injury

emergency hysterectomy

fetal hypoxic injury or death

postpartum hemorrhage

Report Nowescalate immediately

sudden dyspnea in a laboring client Hallmark

a sudden sense of impending doom Hallmark

treat the statement itself as an emergency finding

abrupt hypotension with hypoxia

oozing from intravenous sites Hallmark

the first visible sign of DIC

seizure during or just after delivery

abrupt fetal bradycardia with maternal collapse

Clinical Pearl

Sudden dyspnea, then collapse, then bleeding from every needle site — that sequence in labor is amniotic fluid embolism until proven otherwise.

Amniotic Fluid Embolism