Disease Verification
Disease name: Amniotic fluid embolism (Amniotic fluid embolism) — This is a medically valid term. Based on standard medical knowledge and clinical reports, it is classified as a rare but fatal emergency condition in which amniotic fluid enters the maternal circulation before or after delivery, causing acute cardiopulmonary collapse and coagulopathy.
1) Disease Description (Causes and Pathophysiology, Main Symptoms)
- Causes and pathophysiology
- During labor or immediately after delivery (especially when there is injury or vascular exposure in the uterus or pelvis), amniotic fluid, fetal tissue, and cellular components enter the maternal bloodstream.
- The mechanism involves not only mechanical embolism but also an immunologic (anaphylactoid) reaction, severe pulmonary vasoconstriction, right heart failure, and systemic hypotension.
- Disseminated intravascular coagulation (DIC) commonly accompanies the condition due to activation of intravascular coagulation.
- Main symptoms (usually sudden)
- Acute hypotension, shock, loss of consciousness, or seizures
- Acute dyspnea, hypoxemia, or respiratory arrest
- Bleeding tendency (uterine bleeding or systemic bleeding related to DIC)
- Uterine atony (a cause of increased bleeding)
- Rarely, chest pain, cough, or cyanosis
- Diagnostic features
- There is no specific test. Clinical diagnosis is key (the timing during or around delivery, sudden cardiopulmonary collapse, and coagulopathy).
- Differential diagnoses: pulmonary embolism (thrombotic), myocardial infarction, sepsis, severe uterine bleeding, preeclampsia/eclampsia, etc.
2) Treatment Methods and Precautions (Standard Treatment, Medications·Procedures·Lifestyle Management, Complications)
- Initial management (emergency)
- Immediately manage the ABCs (secure the airway, provide high-concentration oxygen and mechanical ventilation) and perform cardiopulmonary resuscitation, if necessary.
- Rapidly administer intravenous fluids (crystalloid solutions) and maintain blood pressure (using vasopressors).
- Immediately treat reversible causes (such as bleeding) (uterine massage, uterotonics, etc.).
- If the fetus is alive and the pregnant woman is in cardiac arrest, consider a “perimortem cesarean” (decision-making within 4 minutes is recommended if possible).
- Medications/intensive care
- Hemodynamic support: In cases of severe hypotension, use vasopressors such as norepinephrine (preferred), and an inotrope if necessary.
- Mechanical ventilation: Improve oxygenation and manage pulmonary edema.
- Correction of coagulopathy: Correct DIC through massive and component transfusion, including red blood cells, fresh frozen plasma (FFP), platelets, and cryoprecipitate.
- Antibleeding medication: Tranexamic acid (TXA) may be considered depending on the situation, but specialist judgment is required based on the DIC pattern and the bleeding and coagulation status.
- ECMO (extracorporeal membrane oxygenation): May be considered when cardiopulmonary impairment is reversible and there is no improvement with existing treatment.
- Surgical/obstetric management
- Decide on emergency cesarean section (depending on maternal and fetal status) and uterine preservation or removal (hysterectomy in cases of uncontrollable bleeding).
- Precautions related to complications and prognosis
- Common complications: DIC, pulmonary edema, left or right heart failure, neurological injury (hypoxic brain injury), and multiorgan failure.
- Prognosis: High maternal mortality and a high frequency of neurological sequelae among survivors; fetal survival rates vary depending on the circumstances and timing according to reports (for example, up to 70% in some reports).
- Self-management and precautions after discharge
- During recovery from severe illness, cognitive and neurological examinations, rehabilitation, and mental health follow-up are necessary.
- Plans for future pregnancy should be discussed with a high-risk obstetrics team and an anesthesia and intensive care team (the risk of recurrence is low, but a history of this condition classifies the pregnancy as high risk).
3) Outpatient Visit Checklist (Preparation Before a Hospital Visit or Emergency Situation)
- Items/information to prepare
- Current gestational age and the course of labor and delivery (time of membrane rupture, time uterine contractions began, etc.)
- Recently performed test results (blood tests, coagulation tests, electrocardiogram, chest imaging, etc.) and image files, if available
- Medical history: previous cesarean section, instrumental delivery, uterine surgery, history of emergency bleeding, bleeding disorders, allergies, and medications (including anticoagulants)
- Time of symptom onset and progression (whether it occurred suddenly, and when respiratory or consciousness changes occurred)
- Whether there is current bleeding, changes in fetal movement, and the level of consciousness
- Documents·other
- List of current medications and an allergy card
- Emergency contact information (family·spouse)
- Items to note during an outpatient visit (example questions to record for yourself)
- Time symptoms began and the first symptom
- Whether similar symptoms have occurred before
- Any recent infection, fever, pelvic surgery, or uterine manipulation (procedures, amniocentesis, etc.)
4) Examples of General Questions to Ask the Doctor
- What causes this disease, and how likely is it in my situation?
- What is my/the fetus’s current condition (oxygen saturation, amount of bleeding, coagulation indicators)?
- What are the purpose and expected side effects of the recommended emergency treatments (fluids, blood products, surgery, etc.)?
- What is the long-term prognosis after recovery (neurological function, fertility)?
- What should I be careful about during recovery (activities, medications, follow-up tests)?
5) Examples of Disease-Specific Questions
- In an emergency situation involving maternal cardiac arrest, when is a cesarean section (perimortem cesarean) decided on to save the fetus? How likely is it to be performed in our situation?
- If I plan a future pregnancy after this event, what examinations and consultations (high-risk obstetrics, anesthesiology, cardiology, etc.) are needed, and what is the risk of recurrence?
Note: This material is intended to provide clinical information. For actual diagnosis and treatment, evaluation by the responsible medical team and decisions based on the circumstances at the site take priority.