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Amniotic fluid embolism

Amniotic fluid embolism and obstetric anesthesia

• Can occur at any stage of pregnancy
• Amniotic fluid enters maternal circulation
• Leads to multi-organ compromise
• Symptoms: dyspnea, tachypnea, cyanosis, shock, pulmonary edema, seizures
• 25% die within the first hour
• Hallmark signs: respiratory failure, neurologic symptoms, hypotension, DIC
• Therapy: fluids, CPR, blood, vasopressors
• Predisposing factors: advanced age, tumultuous labor, fetal demise, high parity, fetal macrosomia, placenta accreta, uterine rupture,          Cesarean section
• Prerequisites for amniotic fluid embolism: ruptured membranes, ruptured vessels, pressure gradient
• Scenarios: rupturing of membranes, IV saline infusion, uterine stimulants, Cesarean section
• Responsible for 10% of maternal fatalities in the United States; mortality is 70%.
• Causes are Cesarean sections, amniocentesis, and abdominal trauma.
• Signs and symptoms are: dyspnea, cyanosis, hypotension, cardiac arrest
• Immediate Cesarean is needed to save fetus.
• Problems are caused by the release of histamine, bradykinin, cytokinase, prostacyclin, and thromboxane.

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