Amniotic Fluid Embolism: Recognizing the Signs

About this course

An amniotic fluid embolism (AFE) is a rare but life-threatening pregnancy complication. It occurs when amniotic fluid or fetal elements enter the mother's bloodstream (maternal pulmonary circulation) and set off a series of reactions to induce severe cardiovascular and respiratory collapse. Amniotic fluid embolism is the second leading cause of maternal deaths and peripartum cardiac arrest in the United States (US), yet only occurs in less than 1% of pregnancies. This course discusses the clinical presentation of an amniotic fluid embolism, its incidence in the United States, differential diagnoses, and treatment options. This course will also discuss nursing considerations and the importance of immediate management to improve the survival of patients with AFE.

Learning objectives

• Describe amniotic fluid embolism and common signs and symptoms
• Review the causative factors of amniotic fluid embolism, and how those causes can be mitigated to reduce the risk of amniotic fluid embolism
• Differentiate amniotic fluid embolism from other medical conditions that may pose similar signs and symptoms
• Review treatment options to improve the chance of survival of a patient with an amniotic fluid embolism
• Discuss nursing considerations as they relate to amniotic fluid embolism

Course outline

13 sections · finish in any order across devices

1. 1

   Introduction

   An amniotic fluid embolism (AFE) is a rare but life-threatening pregnancy complication. It occurs when amniotic fluid or fetal elements enter the mother's bloodstream (maternal pulmonary circulation) and set off a series of reactions to induce severe cardiovascular and respiratory collapse.1

   4 min

2. 2

   Physiology of Amniotic Fluid Embolism (AFE)

   To fully understand the characteristics of an amniotic fluid embolism, it is first critical to understand the features and functionality of the placenta, a transient or temporary organ formed during pregnancy and expelled after birth. This specialized organ develops within the first few weeks of pre

   6 min

3. 3

   Amniotic Fluid Embolism Incidences

   Amniotic fluid embolisms have the second highest maternal mortality rate in the US but are among the most challenging pregnancy-related complications to study because of their low incidence. General estimates suggest 1 in every 8,000 – 30,000 pregnant women may suffer from an AFE, resulting in 0.8 –

   4 min

4. 4

   FTR Rate

   AFE with cardiac arrest and coagulopathy

   4 min

5. 5

   Causes

   Historically, it was believed that an AFE resulted from the accumulation of amniotic fluid and fetal elements that caused a mechanical obstruction in the pulmonary arteries, hence the condition being categorized as an embolism.15 However, research has revealed otherwise, showing amniotic fluid is so

   4 min

6. 6

   Signs and Symptoms

   Typically, a woman in the early phases of an AFE may experience several nonspecific symptoms including, but not limited to, headaches, cough, chest pain, nausea, sweating, chills, vomiting, and palpitations.1, 3, 15 However, these signs are very similar to normal pregnancy symptoms and are often dis

   4 min

7. 7

   Differential Diagnoses

   As no definitive diagnostic tests or pathological markers can diagnose AFE, differential diagnoses are made to rule out other potential conditions that can cause similar symptoms.15

   4 min

8. 8

   Pulmonary Embolism

   A pulmonary embolism (PE) is the obstruction of a pulmonary artery, often caused by a moving clot known as an embolus. The most common symptoms include sharp and sudden chest pain, shortness of breath, heart palpitations, dizziness, coughing with bloody mucus, and leg pain or swelling.16 While a pul

   4 min

9. 9

   Peripartum Cardiomyopathy

   Peripartum cardiomyopathy (PPCM) is defined as heart failure between the last month of pregnancy and five months post-delivery.16 However, PPCM is generally seen in the late antepartum period or during the first-month post-delivery. Amniotic fluid embolism, on the other hand, can occur at any time d

   4 min

10. 10

    Myocardial Infarction

    Myocardial infarction, more commonly known as a heart attack, is caused by decreased blood flow to the heart muscles. Myocardial infarction has the potential to progress to a cardiac arrest and shows typical ST-T wave changes and elevated of serial cardiac enzymes.19 A bedside echocardiography would

    4 min

11. 11

    Treatment Options

    An AFE is a medical emergency. Treatment must be aggressive with a focus on prompt cardiopulmonary resuscitation of the mother and rapid delivery of the fetus.

    4 min

12. 12

    Nursing Considerations

    While it is difficult to predict who is most at risk of an AFE, steps can be taken to reduce the risk. First, trauma to the uterus must be avoided during any medical procedure, such as the insertion of a pressure catheter. Also, incisions to the placenta must be avoided during cesarean delivery to p

    4 min

13. 13

    Conclusion

    An amniotic fluid embolism is a rare but catastrophic pregnancy complication with few preventative measures or predicting diagnostics. The condition is exceptionally complex by nature and can progress rapidly to severe internal bleeding and sudden cardiopulmonary collapse.

    4 min

This course satisfies

Requirement summaries come from our state requirement records. Always confirm details with your board before you renew.

References and resources

• Amniotic fluid embolism. (2016). Pulmonary Embolism, 182-183. https://doi.org/10.1002/9781119039112.ch35
• Mazza, G. R., Youssefzadeh, A. C., Klar, M., Kunze, M., Matsuzaki, S., Mandelbaum, R. S., Ouzounian, J. G., & Matsuo, K. (2022). Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism. JAMA Network Open, 5(11), e2242842. https://doi.org/10.1001/jamanetworkopen.2022.42842
• Fitzpatrick, K. E., van den Akker, T., Bloemenkamp, K. W. M., Deneux-Tharaux, C., Kristufkova, A., Li, Z., Schaap, T. P., Sullivan, E. A., Tuffnell, D., & Knight, M. (2019). Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Medicine, 16(11). https://doi.org/10.1371/journal.pmed.1002962
• Kaur, K., Bhardwaj, M., Kumar, P., Singhal, S., Singh, T., & Hooda, S. (2016). Amniotic fluid embolism. Journal of Anaesthesiology, Clinical Pharmacology, 32(2), 153–159. https://doi.org/10.4103/0970-9185.173356
• Burton, G. J., & Fowden, A. L. (2015). The placenta: a multifaceted, Transient Organ. Philosophical Transactions of the Royal Society B: Biological Sciences, 370(1663), 20140066. https://doi.org/10.1098/rstb.2014.0066
• Bacsi, A., Pan, L., Ba, X., & Boldogh, I. (2016). Pathophysiology of Bronchoconstriction: Role of Oxidatively Damaged DNA Repair. Current Opinion in Allergy and Clinical Immunology, 16(1), 59–67. https://doi.org/10.1097/ACI.0000000000000232
• Pulmonary Artery Occlusion - an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. Retrieved June 13, 2023, from https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/pulmonary-artery-occlusion#:~:text=Acute%20pulmonary%20artery%20obstruction%20increases
• Beitzke, D., Wolf, F., Edelhauser, G., Lammer, J., & Loewe, C. (2011). Right heart dilatation in adult congenital heart disease: imaging appearance on cardiac magnetic resonance. The British Journal of Radiology, 84(998), 188–193. https://doi.org/10.1259/bjr/13711325
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• Liao, C.-Y. (2016). Amniotic Fluid Embolism with Isolated Coagulopathy: A Report of Two Cases. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2016/21720.8615
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• Felis, S. (2023). Uterine atony. American Journal of Medical and Clinical Research & Reviews, 02(11), 01-08. https://doi.org/10.58372/2835-6276.1097
• Mazza, G. R., Youssefzadeh, A. C., Klar, M., Kunze, M., Matsuzaki, S., Mandelbaum, R. S., Ouzounian, J. G., & Matsuo, K. (2022). Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism. JAMA Network Open, 5(11), e2242842. https://doi.org/10.1001/jamanetworkopen.2022.42842
• Amniotic Fluid Embolism. (n.d.). NORD (National Organization for Rare Disorders). https://rarediseases.org/rare-diseases/amniotic-fluid-embolism/
• Obanolu, U. (2012). Risk factor for pulmonary embolism. Pulmonary Embolism. https://doi.org/10.5772/32260
• Goland, S., & Mouquet, F. (2021). Risk stratification in patients newly diagnosed with peripartum cardiomyopathy. Peripartum Cardiomyopathy, 21-31. https://doi.org/10.1016/b978-0-12-817667-2.00003-7
• Littlejohn, J. E. (2020). Postoperative septic shock. Cardiothoracic Critical Care, 111-120. https://doi.org/10.1093/med/9780190082482.003.0010
• Chadwick Jayaraj, J., Davatyan, K., Subramanian, S., & Priya, J. (2019). Epidemiology of myocardial infarction. Myocardial Infarction. https://doi.org/10.5772/intechopen.74768
• Vachhani, S. (2016). Venous gas embolism (VGE) in a patient with ovarian cancer during laparoscopic surgery. https://doi.org/10.26226/morressier.57108e30d462b80290b4a6b
• Noori, M., & Nelson-Piercy, C. (2016). Pathophysiology and management of pre-eclampsia, eclampsia, and HELLP syndrome. Oxford Medicine Online.
• Misbah, S. (2018). Suspected anaphylaxis. Oxford Medicine Online. https://doi.org/10.1093/med/9780199568741.003.0075
• She, YJ., Liu, WX., Wang, LY. et al. The impact of height on the spread of spinal anesthesia and stress response in parturients undergoing caesarean section: a prospective observational study. BMC Anesthesiology 21, 298 (2021). https://doi.org/10.1186/s12871-021-01523-2
• Kaur, K., Bhardwaj, M., Kumar, P., Singhal, S., Singh, T., & Hooda, S. (2016). Amniotic fluid embolism. Journal of Anaesthesiology, Clinical Pharmacology, 32(2), 153–159. https://doi.org/10.4103/0970-9185.173356
• Moore, J., & Baldisseri, M. R. (2005). Amniotic fluid embolism. Critical Care Medicine, 33(Supplement), S279–S285. https://doi.org/10.1097/01.ccm.0000183158.71311.28
• Steiner, P. E., & Lushbaugh, C. C. (1986). Landmark article, Oct. 1941: Maternal pulmonary embolism by amniotic fluid as a cause of obstetric shock and unexpected deaths in obstetrics. By Paul E. Steiner and C. C. Lushbaugh. JAMA, 255(16), 2187–2203. https://doi.org/10.1001/jama.255.16.2187
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