Bloods - FBC, U&E, calcium and magnesium, clotting studies, ABG.It is therefore difficult to confirm the diagnosis and the focus should therefore revolve around resuscitation and stabilisation of the patient. The differential diagnosis will include other conditions that present in this way - such as pulmonary embolism, anaphylaxis, sepsis, eclampsia and myocardial infarction. Disseminated intravascular coagulation (this may be the first sign in some cases however nearly all patients will go on to develop this within 4 hours).It is characterised as an acute condition with the sudden onset of: As such, the manifestations of this complication of pregnancy resemble these disease processes. The physiology related to amniotic fluid embolism has been described as similar to anaphylaxis or severe sepsis. Fig 1 - Caesarean section is a risk factor for amniotic fluid embolism. However should cardiac arrest or severe maternal compromise occur, perimortem section is indicated to facilitate CPR of the mother.ĭefinitive diagnosis of amniotic fluid embolism is only definitively confirmed on post mortem and demonstrates fetal squamous cells along with debris in the pulmonary vasculature. If the baby is not yet delivered and the patient is relatively stable, continuous fetal monitoring should be instigated with a view to imminent delivery. All of this coordination should occur whilst rapid maternal resuscitation is administered.īasic ABCDE approach must not be forgotten, with high flow oxygen essential to minimise neurological compromise and fluids given as appropriate in order to counteract hypotension and haemodynamic instability.Īnaesthetics will be involved with measuring pulmonary artery wedge pressures and they will be able to take blood to assist with the diagnosis (shows fetal elements in the aspirate).ĭisseminated intravascular coagulation should be managed with the involvement of haematologists. If this condition is suspected, anaesthetics must be involved to arrange intensive care admission. Bloods – FBC, U&E, calcium and magnesium, clotting studies, ABGĮarly involvement of the multidisciplinary team is important.Investigations are similar to those undertaken during cardiac arrest and other emergency scenarios. The mainstay of management in amniotic fluid embolism is resuscitation.
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