Obstetric emergencies

Amniotic fluid embolism (AFE) is an obstetric emergency. Which one of the following

statements is TRUE?

a) Polyhydramnios is a proven risk factor

b) AFE most commonly occurs during caesarean section

c) Regarding symptoms of AFE, headache is more common than chest pain

d) Presence of foetal squamous cells in the pulmonary vasculature is diagnostic

e) Delivery of the baby is not a priority in terms of improving maternal outcome

Answer: c

Explanation

Amniotic fluid embolism (AFE) is the peri-partum translocation of amniotic fluid,

foetal cells and debris into the maternal circulation. There are no proven risk factors

for AFE but polyhydramnios is an association. Of AFE cases, 70% occur during labour,

19% during caesarean section and 11% following vaginal delivery. Presenting symptoms

(in order of frequency) are dyspnoea, cough, headache and chest pain. Presence

of foetal squamous cells in the pulmonary vasculature is neither sensitive nor specific,

but was once considered diagnostic. Management priorities are early recognition,

immediate resuscitation and delivery of the baby. Life-threatening complications

include cardiorespiratory collapse and haemorrhage secondary to disseminated intravascular

coagulation.

Reference

Dedhia J, Mushambi M. Amniotic fluid embolism. Contin Educ Anaesth Crit Care Pain

2007; 7(5): 152–6.