With the massive afterload on the RV, on echocardiogram you can see a dilated RV with ballooning of the ventricular septum towards the left. The best way to think about these coming together (and potentially a valid way to think pathophysiologically too) is a massive, anaphylactoid reaction. This vasoconstriction results in acute cor pulmonale - or sudden right ventricular failure.Īccompanying this is acute respiratory failure and severe hypoxemia. Whether amniotic fluid passing into maternal circulation is the underlying cause or not, there are a fair number of subsequent clinical manifestations that can be observed.įirst, there is massive pulmonary vasoconstriction and possible mechanical obstruction of pulmonary vasculature due to amniotic fluid components. It’s unclear what exactly causes AFE, but again, it’s often reported at the time of some disruption of maternal-fetal interface. What causes AFE? What's the pathophysiology? There is some potential relation related to moments where, “exchange of fluids between fetal and maternal compartments is more likely,” such as operative or cesarean delivery, placenta previa, placenta accreta, abruption Incidence is hard to know given its rarity - likewise, predicting AFE is also impossible - there are no defined and true risk factors. No lab test can confirm or refute the diagnosis.Ī national registry reports with respect to case timing: Based on this triad and exclusion of other potential causes.Ĭases are often dramatic - preceded not infrequently by impending sense of doom from patient, change in mental status, agitation.įetal status may also change with sudden profound decelerations, loss of variability, and terminal bradycardia.
Often profound with bleeding from venipuncture or surgical sites, hematuria, GI hemorrhage, vaginal bleeding, epistaxis. Hypotension, often resulting in cardiac arrest / cardiovascular collapseĬoagulopathy may be in conjunction with cardiopulmonary symptoms, or follow them. Read along: SMFM Clinical Guideline 9: AFE: diagnosis and managementĪFE is a clinical diagnosis characterized by a triad of sudden onset symptoms:
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