Amniotic fluid embolism

• Devyatova E.A.

Abstract

Objective. Amniotic fluid embolism (AFI) is rather rare serious and extremely severe obstetric complication characterized with cardiovascular and respiratory collapse, coagulopathy. AFI is one of the main reasons of maternal mortality in developed countries which is classical example of the disease of unclear pathogenesis due to low-quality data and expert clinical analysis absence. There are no verified diagnostic methods of AFI detection, and forehanded diagnostic performs challenges.

Aim. Analysis of modern scientific data concerning AFI pathophysiology and offspring, achievements in diagnostic and management of this severe obstetric complication.

Materials and methods. Limited to the English literature PubMed, EMBASE, MedLine and the Cochrane Library were searched for data including clinical researches, case series and registers from 2012 to 2014, devoted to different AFI aspects: pathophysiology, risk factors, medical approach, offspring and prognosis.

Results. AFI is one of the most devastating conditions in obstetric care and its pathophysiology appears to involve activation of proinflammatory mediators similar to that seen with the classic systemic inflammatory response syndrome. The syndrome appears to be mother’s immunological answer to different antigen stimulators which may be of fetal or infectious origin. In predisposed «mother – fetus» pairs AFI is unpreventable. AFI diagnosis is based on three principal clinical signs: hypotension, hypoxic disorders and coagulopathy. Verified AFI diagnosis is out of access. ROTEM and TEG usage are rather helpful in diagnosis of coagulopathy disorders which gives an opportunity to start antifibrinolitic therapy if hyperfibrinolisis is detected. rVII administration is not recommended for routine management. Maternal treatment is primarily supportive, whereas prompt delivery of the mother who has sustained cardiopulmonary arrest is critical for improved newborn outcome.

Keywords:amniotic fluid embolism, risk management, embolism diagnosis and management, maternal mortality, newborns’ mortality

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