Amniotic Fluid Embolism

Meet the patient

A 33-year-old woman, gravida 4 para 3, delivers by forceps at 39 weeks. Eight minutes later she says she feels like she is going to die, turns cyanosed, gasps, seizes and arrests. Her IV sites ooze and her perineal repair bleeds. Bedside echo shows a dilated right ventricle and a globally stunned left ventricle.^[2][11]

Two questions decide her next hour, and they decide every AFE: is this unexplained peripartum collapse with coagulopathy? — then it is AFE until proven otherwise — and can I resuscitate, deliver and support the circulation in time? — the clock answers over minutes. Hold those two and the pathway below slots into place.^[1]

References16ShowHide

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12. [12]Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies Am J Obstet Gynecol, 2016.PMID 27372270
13. [13]Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, et al. Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study BJOG, 2016.PMID 25683758
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