Amniotic Fluid Embolism

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 patient 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 after birth — usually soon after, but up to 48 hours later. Risk factors exist but predict almost nothing, so the condition is treated as unpredictable and unpreventable — recognition and speed are what the nurse contributes.