Amniotic-fluid-embolism

Amniotic-fluid-embolism - UPDATE UPDATE ON ON AMNIOTIC...

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Unformatted text preview: UPDATE UPDATE ON ON AMNIOTIC FLUID EMBOLISM AMNIOTIC FLUID EMBOLISM (AFE) (AFE) Dr. JEHAD YOUSEF Dr. JEHAD YOUSEF FICS, FRCOG FICS, FRCOG ALHAYAT HOSPITAL ALHAYAT HOSPITAL AMMAN-JORDAN AMMAN-JORDAN AMNIOTIC FLUID EMBOLISM • AFE is thought to occur when amniotic fluid , fetal cells, hair, or other debris enter the maternal circulation. • Ricardo Meyer (1926); reported the presence of fetal cellular debris in the maternal circulation. • Steiner and Luschbaugh (1941) described the autopsy findings of eight cases of AFE. • Until 1950, only 17 cases had been reported. • AFE was not listed as a distinct heading in causes of maternal mortality until 1957 when it was labeled as obstetric shock. • Since then more than 400 cases have been documented, probably as a result of an increased awareness. AMNIOTIC FLUID EMBOLISM • Overall incidence ranges from 1 in 8,000 to 1 in 80,000 pregnancies. • 10% of maternal deaths in USA &16% in U.K. • The first well-documented case with ultimate survival was published in 1976 (Resnik R, et al. Obstet Gynecol 1976;47:295-8). • 75 % of survivors are expected to have long-term neurologic deficits. • If the fetus is alive at the time of the event, nearly 70 % will survive the delivery but 50% of the survived neonates will incur neurologic damage. AMNIOTIC FLUID EMBOLISM • Time of event: - During labor. - During C/S.- After normal vaginal delivery.- During second trimester TOP. • AFE syndrome has been reported to occur as late as 48 hours following delivery. Risk factors of AFE • Advanced maternal age • Multiparity • Meconium • Cervical laceration • Intrauterine foetal death • Very strong frequent or uterine tetanic contractions • Sudden foetal expulsion (short labour) • Placenta accreta • Polyhydramnios • Uterine rupture • Maternal history of allergy or atopy • Chorioamnionitis • Macrosomia • Male fetal sex • Oxytocin (controversial) Nevertheless, these and other frequently cited risk factors are not consistently observed and at the present time Experts agree that this condition is not preventable. Experimental AFE The cardiorespiratory effects of acute intravascular injection of amniotic fluid have been studied in pregnant ewes : • The initial response was hypotension. • A 40 % decrease in mean arterial pressure was followed by a 100 % increase in mean pulmonary artery pressure. • Little change occurred in the left atrial pressure or the pulmonary artery wedge pressure. • A 40 percent fall in cardiac output was associated with the rapid rise in pulmonary artery pressure. • These changes resulted in a two- to threefold increase in pulmonary vascular resistance and a two- to threefold decrease in systemic vascular resistance. Experimental AFE • Intravascular injection of amniotic fluid in rhesus monkeys failed to produce cardiovascular changes similar to the syndrome observed in pregnant ewes or humans. Pathophysiology- Poorly understood....
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This note was uploaded on 01/11/2012 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Amniotic-fluid-embolism - UPDATE UPDATE ON ON AMNIOTIC...

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