Amniotic Fluid Embolism

Occurs when amniotic fluid, fetal cells, hair, or other debris enter the maternal bloodstream, usually during:

• Labor or delivery
• Cesarean section
• Uterine trauma (e.g., rupture, instrumentation)

This triggers a systemic inflammatory reaction, anaphylactoid response, and DIC (disseminated intravascular coagulation)

• Amniotic fluid contains tissue factor (thromboplastin) and other procoagulant substances that activate the coagulation cascade, leading to DIC (disseminated intravascular coagulation).

Typically occurs during labor, immediately after delivery, or postpartum (within 30 minutes)

Clinical Presentation

1. Sudden respiratory distress
   • Hypoxia
   • Dyspnea
   • Cyanosis
2. Cardiovascular collapse
   • Hypotension
   • Tachycardia
   • Cardiac arrest
3. DIC
   • Massive bleeding (vaginal, IV sites)
   • Prolonged coagulation tests (↑ PT/PTT)
   • ↓ Platelets, ↓ fibrinogen

Can also include seizures, altered mental status, and coma

Labs

• ABG: hypoxemia, respiratory/metabolic acidosis
• Coags: ↑ PT/PTT, ↓ fibrinogen, thrombocytopenia
• CBC: ↓ platelets
• D-dimer: ↑↑ (due to DIC)