Amniotic fluid embolism treatment3/9/2023 ![]() This is thought to occur from a combination of damage from the amniotic fluid debris and subsequent immune reactions. AFE is a complication of pregnancy where amniotic fluid enters the maternal pulmonary circulation causing sudden and catastrophic cardiovascular collapse. This week, we’ll discuss amniotic fluid embolism (AFE) and a potential drug combination that can be used in this emergent situation. Hello and welcome to Episode 49 of ER-Rx. – Ketorolac (at a dose of 30 mg) blocks thromboxane, which is a major platelet activator – Ondansetron (at a dose of 8 mg) blocks serotonin receptors, which are found in vagal terminals of the heart and lungs and cause pulmonary vasoconstriction It also reverses bradycardia that can occur during AFE – Atropine (at a dose of 1 mg) blocks vagal stimulation and reverses parasympathetic activity that causes pulmonary artery spasm and vasoconstriction. This “A-OK” regimen is directed at some of the mediators thought to cause or contribute to AFE – Based on anecdotal evidence and case reports, a combination of atropine, ondansetron, and ketorolac may be used for refractory cases. Priorities include controlling hemorrhage and reversing coagulopathy with TXA and massive transfusion protocols, hemodynamic support with fluids and vasopressors, respiratory support, and delivery of the fetus ![]() – Treatment is focused on early recognition and resuscitation. Activation of factor VII and platelets also activates the coagulation cascade, causing DIC and eventually multi-organ failure AFE may be in part caused by serotonin and thromboxane induced platelet dysfunction, degranulation, and pulmonary hypertension. – The pathophysiology of AFE is unknown, but is thought to be a complex phenomenon involving numerous mediators that cause anaphylactoid reactions and complement activation once amniotic fluid enters maternal circulation. Less commonly, disseminated intravascular coagulation (DIC) may be the initial presenting feature Other symptoms include hypotension, loss of consciousness, hemorrhage, and seizure-like activity. – Signs/ symptoms of AFE include respiratory distress, cardiovascular collapse, and coagulopathy. ![]() ![]() AFE is the second leading cause of maternal death in the US and Europe AOG.– Amniotic fluid embolism (AFE) is a complication of pregnancy where amniotic fluid enters the maternal pulmonary circulation causing sudden cardiovascular collapse. Extracorporeal therapies for amniotic fluid embolism. Amniotic fluid embolism: Principles of early clinical management. Amniotic fluid embolism causing catastrophic pulmonary vasoconstriction: Diagnosis by transesophageal echocardiogram and treatment by cardiopulmonary bypass. Stanten RD, Iverson LI, Daugharty TM, et al. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. Flitzpatrick KE, van den Akker T, Bloemenkamp KWM, et al. Amniotic fluid embolism incidence, risk factors and outcomes: A review and recommendations. Ces astuces visent à fournir aux cliniciens de l’information qui pourrait améliorer leur capacité à poser un diagnostic en temps opportun et à assurer un traitement de soutien approprié aux patientes atteintes d’une embolie amniotique.ġ. Dans cet article, nous présentons cinq énoncés clés qui portent sur les facteurs de risque, le tableau clinique et la prise en charge de l’embolie amniotique dans un contexte clinique. Malgré la rareté de cette affection, la morbidité et la mortalité maternelles et périnatales sont importantes, même dans les cas où le traitement est idéal. L’embolie amniotique est un événement catastrophique d’apparition soudaine qui doit être détecté immédiatement. The purpose of these tips is to provide clinicians with information that may improve their ability to make a timely diagnosis and establish appropriate supportive treatment to patients suffering from AFE. In this article, we present five key statements covering the risk factors, clinical presentation, and management of AFE in a clinical setting. Despite the rarity of this condition, both maternal and perinatal morbidity and mortality are significant with AFE, even in cases ideally managed. Amniotic fluid embolism (AFE) is a catastrophic, sudden-onset event that must be recognized immediately.
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