Amniotic fluid embolism

• 1:80,000 deliveries
• > 80% mortality

• Passage of amniotic fluid and debris into the maternal circulation causes an anaphylactic-type reaction

• May occur antenatally
• Risk factors include :

1.  increasing maternal age, 
2.  hypertonic uterine contractions, 
3.  use of uterotonic agents, 
4.  induction of labour and 
5.  uterine trauma

• Criteria for diagnosis include acute hypotension or cardiac arrest, acute hypoxia, coagulopathy, onset during labour, C/S or within 30 min of delivery and absence of other potential explanations for the above presentation
• If diagnosed before death, management is supportive - 
give O2, maintain circulation, treat DIC and manage in ITU. 
Discuss heparin therapy with haematologist
• Fetal survival 79% with 39% neurologically intact.