![]() ![]() Recent immunologic studies provide a new approach to the study of the pathophysiology of AFE. Cardiac mast cells constitute a central pathogenesis of anaphylactic (immunoglobulin E-dependent) and anaphylactoid (immunoglobulin E-independent) reactions. They are associated with complement activation and subsequent postpartum hemorrhage. Second, anaphylactic and anaphylactoid reactions of the remaining AFE are also relatively unexpected and fetal antigen dose independent and can occur at the first exposure to amniotic fluid components. Given the disastrous entry of amniotic fluid into the maternal circulation, they experience a sudden cardiopulmonary collapse (mechanical obstruction subtype). First, adverse reactions in AFE are usually unexpected and fetal antigen dose dependent. There appears to be at least 2 mechanisms. ![]() The aim of the present study was to investigate the pathophysiology of AFE.Ī search was conducted between 19 through the English-language literature (online MEDLINE PubMed database) using the keyword amniotic fluid embolism combined with anaphylaxis, anaphylactoid, complement activation, mast cells, fetal antigens, and idiosyncratic.Īmniotic fluid embolism is a rare clinical entity but a severe obstetric emergency that can be lethal even in previously healthy women in labor or in the early postpartum period. All rights reserved.Amniotic fluid embolism (AFE) is a rare but severe emergency in obstetrics. Excessive fluid administration should be avoided (GRADE 1C) and (7) because coagulopathy may follow cardiovascular collapse with amniotic fluid embolism, we recommend the early assessment of clotting status and early aggressive management of clinical bleeding with standard massive transfusion protocols (GRADE 1C).Īmniotic fluid embolism cardiorespiratory arrest pregnancy.Ĭopyright © 2016 Elsevier Inc. We recommend the following: (1) we recommend consideration of amniotic fluid embolism in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman (GRADE 1C) (2) we do not recommend the use of any specific diagnostic laboratory test to either confirm or refute the diagnosis of amniotic fluid embolism at the present time, amniotic fluid embolism remains a clinical diagnosis (GRADE 1C) (3) we recommend the provision of immediate high-quality cardiopulmonary resuscitation with standard basic cardiac life support and advanced cardiac life support protocols in patients who develop cardiac arrest associated with amniotic fluid embolism (GRADE 1C) (4) we recommend that a multidisciplinary team including anesthesia, respiratory therapy, critical care, and maternal-fetal medicine should be involved in the ongoing care of women with AFE (Best Practice) (5) following cardiac arrest with amniotic fluid embolism, we recommend immediate delivery in the presence of a fetus ≥23 weeks of gestation (GRADE 2C) (6) we recommend the provision of adequate oxygenation and ventilation and, when indicated by hemodynamic status, the use of vasopressors and inotropic agents in the initial management of amniotic fluid embolism. ![]() Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used for defining the strength of recommendations and rating quality of the evidence. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. ![]() Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. The search was restricted to English-language articles published from 1966 through March 2015. Despite recent advances in our understanding of this condition, it remains enigmatic, unpre- ventable, and in most cases, untreatable as well. We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism.Ī systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library. Amniotic fluid embolism is a devastating obstetric condition with a mortality rate as high as 80. ![]()
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