Amniotic Fluid Embolism: Management

AMNIOTIC FLUID EMBOLISM MANAGEMENT

• One of the leading cause of death • 27 /331 deaths in 4yrs (CRMD )

UNPREDICTABLE UNPREVENTABLE

UNTREATABLE

SYMPTOMS • • • • •

Convulsion Coagulation problems Chest discomfort- pain,dyspnoea Restlessness Vomiting

• Collapse • Cardio respiratory Arrest

Predisposing Factors • • • •

Oxytocics--- Hyper stimulation ARM Combined use of Prostaglandin & Pitocin Use of smooth muscle relaxants

When? • Labour (late stage) • Immediate postpartum • Upto 30 min after delivery

Common Scenario • Woman becoming a/c dyspnoeic, cough Change in behavior peripheral cyanosis confusion Hypotension Seizures Coma

Diagnosis • Clinical finding • Confirmed – fetal squamus & lanugo hair in pulmonary vasculature

NOT PREVENTABLE Rapid deterioration Little time for rescue

Prevention of predisposing factors • Do not combine PG & Oxytocin • Do not use PG in soft , well effaced cervix • Interval between PG PG E2 -6 hrs PG E 1 -4hrs

Management • Early Recognition • Aggressive resuscitation

• Resuscitation Trolley regularly checked expiry date of drugs • A person identified for maintenance (Head Nurse) • Laryngoscope, Ambubag

Code Blue • Mechanism to quickly summon Anesthesiologist Physician Cardiologist

Blood & blood products

• Written Protocols dose route of administration displayed in LR • Drills