doctors who specialize in amniotic fluid embolism

Instead, AFE is a syndrome that is diagnosed clinically.8 Currently, no diagnostic test exists for AFE. Debate continues regarding a mast cell degranulation with ana-phylaxis hypothesis versus a complement activation theory. Findings of incomplete uterine tears in similar patients by Attwood in 19725 and the discovery of fetal squamous cells in central venous catheter aspirate by Resnik et al6 in 1976 supported this theory of cause and effect of the 'most catastrophic event possible in the gravid female.'3,4įinding amniotic fluid or products of conception through right heart catheterization is neither sensitive nor specific for AFE, as squamous cells aspirated from a pulmonary artery catheter can be found in nonpregnant women and in normal pregnant women.7 The etiology of AFE is unclear. More evidence was demonstrated by Gross and Benz in 1947, when postmortem centrifuged blood from the right heart after a maternal death revealed amniotic fluid and debris. These examinations revealed emboli in maternal pulmonary vessels with fat-positive aggregates and squamous epithelial cells suggestive of amniotic fluid. They included descriptions of postmortem examinations after 42 unexplained obstetric deaths with similar clinical scenarios. The first published case report of amniotic fluid entering maternal circulation was written by Meyer in 1926 however, the seminal work of Steiner and Lushbaugh4 in 1941 was most informative. Historically, AFE was thought to be caused by passage of amniotic fluid through tears in the uterus or cervix into the vasculature. The use of a case report, which will illustrate pertinent points of diagnosis and management. Butler is Director of Obstetrics, Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina.Īll faculty and staff in a position to control the content of this CME activity, and their spouses/partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Worly is an Obstetrician/Gynecologist, Department of Obstetrics and Gynecology, Thomas Jefferson University, 834 Chestnut St, Ste 400, Philadelphia, PA 19107 E-mail: and Dr. The purpose of this lesson is to address this knowledge gap throughĭr.

However, because AFE is so uncommon, there is a significant gap between ideal management and typical ability of the physician to care for such a patient. Given the dramatic presentation of AFE and the high mortality rate, it is incumbent on the obstetrician/gynecologist (OB/GYN) to recognize and effectively initiate treatment on an emergent basis. What makes this condition even more devastating is the high mortality rate, which ranges from 20% to 90%.1-4 Unfortunately, a definitive diagnosis can only be made clinically and is otherwise a diagnosis of exclusion. Patients often have premonitory symptoms, including shortness of breath, chest pain, nausea, vomiting, numbness, tingling, agitation, and a sense of 'impending doom.' Typically presenting 30 minutes before or after birth, this rare disease is thought to occur between 1 in 8000 and 1 in 80,000 deliveries, depending on the definition used. Instead, 'anaphylactoid syndrome of pregnancy' or more specifically 'complement activation of pregnancy' may better describe this condition involving sudden cardiovascular collapse, altered mental status, and disseminated intravascular coagulopathy (DIC). Identify the risk factors for an amniotic fluid embolism (AFE).Īmniotic fluid embolism (AFE) is a misnomer it is neither caused by amniotic fluid nor does an embolism necessarily occur. Learning Objectives: After participating in this activity, the obstetrician/gynecologist should be better able to:ġ. A BIWEEKLY PUBLICATION FOR CONTINUING MEDICAL EDUCATION IN OBSTETRICS AND GYNECOLOGYīrett Worly, MD, and Jennifer R.

Doctors who specialize in amniotic fluid embolism