AMNIOTIC FLUID EMBOLISM (AFE)
Maternal Mortality (otherwise referred to in some places in this article as “Maternal Death”), is best acknowledged as the death of a woman while she is pregnant or within 42 days of end of pregnancy. According to epidemiological survey however (CIA world factbook) in 2011, Nigeria was grouped in the Maternal Mortality Ratio (MMR) Zone of approximately 300-500 deaths per 100,000 women of childbearing age for the year. Going by this statistic in mind, I ran that estimate to about 300,000 – 500,000 deaths in 100,000,000 (a hundred million; at least the country’s population is a bit over 160,000,000).
One rare and not so completely understood condition that contributes its own quota to maternal deaths, is the Amniotic Fluid Embolism (AFE). The Amniotic fluid (liqor Amni) is the fluid enclosing the fetus within the sac. When the amniotic fluid, fetal hair, cells, debris or clot, through the placenta, enters into the mother’s bloodstream, triggering an allergic reaction (which results in cardio-respiratory collapse), this can be described as Amniotic Fluid Embolism (AFE). This condition was first described in 1926 by J.R Meyer, but the first maternal death from this condition wasn’t recorded until 1941.
As earlier said, this condition is a bit rare as reported cases and recent studies show to be about 1 in 20,500 deliveries, it is still reported to be the fifth (5th) most common cause of maternal mortality in the world.
HOW IS IT RECOGNISED?
Once the condition sets in, the first signs are hypotension (Low blood pressure) & acute respiratory distress syndrome (ARDS), which is then followed rapidly by a cardiac failure. This stage induces a huge reduction in blood supply in the heart and to the lungs, at which point, a coma is inevitable. Seizures have also often been presented. The risk with this therefore is the inconsistency of & non-specific diagnosis to immediately recognize and definitively Identify this condition when it occurs.
The next stage after the afore described, is the hemorrhagic (severe blood loss) stage and this is due to blood losing its ability to clot. We shouldn’t lose sight of the fact that the fetus will also be distressed at this point and could die if not delivered. The fetus is being endangered due to the collapse of the cardio-vascular system.
WHO ARE THE LIKELY VICTIMS?
Women who have been induced to laborWomen undergoing caesarean sections or instrumental vaginal deliveryWomen of about 35years or older
WHAT ARE THE CAUSES/ PREDISPOSING FACTORS?
Rupture of the amniotic sacRuptured uterine or cervical veinsProlonged induced laborMultiple pregnancy has also been reported as a predisposing factorAbdominal trauma.
MANAGEMENT OR TREATMENT
Cardiopulmonary resuscitation (CPR) if patient does suffer an arrest.Resuscitation with oxygen to maintain oxygen level and fight against hypoxiaIntravenuous fluids to maintain blood pressurePerimortem caesarean delivery should be carried out –although there has been recommendation for delivery of the infant by caesarean section within five (5) minutes of cardiac arrest to facilitate resuscitation.