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Amniotic Fluid Embolism
Entering of amniotic fluid and fetal particulate materials into maternal blood circulation

Rare : 1:8000 to 1:30,000 pregnancies
Cannot be predicted or prevented
Maternal mortality 13 - 86%.  50% deaths in the first hour
Often not diagnosed until autopsy
20 -40% neonatal mortality: half of survivors have neurological damage
80% of cases occur during lbour and 20% before or after birth

Probably the amniotic fluid enters the maternal circulation due to torn placental membrane, torn uterine veins
May be associated with hypertonic uterus
Anaphylaxis; 40% have H/O atopy/allergy

Risk Factors
? Association between AFE and Oxytocin induction of labour and / or ARM
Advanced maternal age
Repeated Caesarian section >6
Placental abruption, fetal death

Clinical Features
Onset sudden and overhelming
Breathlessness, feeling doomed, chest pain, feeling cold, light headedness, paresthesia, panicking, restlessness, nausea, vomiting
Rapid progression from dyspnoea, hypotension to cardiac arrest
Seizures, coma
Fetal distress

DIC (Disseminated intravascular coagulation)
Cardiac arrest
Major neurological problems

Nursing Interventions
Call for emergency help
Start cardio-pulmonary resuscitation (CPR)
Administer O2
Treat shock with IV fluids
Arrange for emergency Caesarian section
Transfer to ICU
Support and care for the patient and her family

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