Amniotic fluid embolism occurs when some amniotic fluid that contains cells or tissue from the fetus enters a pregnant woman’s bloodstream and causes a serious reaction. (Amniotic fluid is the fluid that surrounds the fetus in the uterus.) This reaction can damage the lungs and heart and cause excessive bleeding.
Amniotic fluid embolism is very rare. It usually occurs during late pregnancy but may occur when an abortion is done during the first or second trimester. While rare, of women who die suddenly during labor, amniotic fluid embolism is one of the most likely causes.
Risk factors
Risk may be increased with
Older maternal age
More than one fetus, such as twins or triplets (see multiple births)
Too much fluid around the baby (polyhydramnios)
Placenta in the wrong position (placenta previa)
Placenta with an abnormally firm attachment to the uterus (placenta accreta)
Placenta detaches too soon (placental abruption)
Abdominal injury
Labor started with medications (induced)
Tear in the cervix
Forceps used during delivery
Symptoms of Amniotic Fluid Embolism
The fluid or tissue can cause a serious reaction in a pregnant woman. The reaction usually occurs during or shortly after labor and delivery. The woman may have a rapid heart rate, an irregular heart rhythm, low blood pressure, and difficulty breathing. She may stop breathing (respiratory failure), or her heart may stop (cardiac arrest). The risk of death is high.
Disseminated intravascular coagulation is a common complication. In this disorder, small blood clots develop throughout the bloodstream, resulting in widespread bleeding with massive loss of blood. Emergency care is required.
Diagnosis of Amniotic Fluid Embolism
A doctor's evaluation
Blood tests
Prompt diagnosis and treatment of amniotic fluid embolism are essential. Doctors may do blood tests to check the function of certain proteins that help the blood to clot normally.
Doctors diagnose amniotic fluid embolism based on symptoms, particularly when a woman has the following symptoms:
Sudden stopping of the heart
Sudden difficulty breathing
Low blood pressure
Widespread, uncontrolled bleeding
Treatment of Amniotic Fluid Embolism
Emergency care team
Cardiopulmonary resuscitation (CPR)
Medications used to induce contractions
Transfusion of blood and blood components
Amniotic fluid embolism is a life-threatening emergency and requires urgent care by a team of specialists with intensive care equipment.
Women with amniotic fluid embolism may be given a transfusion of blood and blood components. Injection of a blood clotting factor (which helps blood clot) may be lifesaving. Women may require assistance with breathing or medications to help the heart contract. CPR is often required.
If CPR does not resolve cardiac arrest in a pregnant woman, the baby may be delivered immediately using forceps or a vacuum device, or cesarean delivery may be done. Delivery can be critical for survival of the woman and lifesaving for the fetus if the fetus is old enough to survive outside the uterus.
Women are given medications used to induce contractions to help avoid excessive bleeding.
