a. Description.

Amniotic fluid embolism refers to the accidental infusion of amniotic fluid into the mother’s bloodstream under pressure from the contracting uterus.

The amniotic fluid enters the maternal blood sinuses through defects in the membranes, after membranes have ruptured or after partial premature separation of the placenta has occurred.

Solid particles suspended in the amniotic fluid enter the maternal circulation (this may be fetal skin cells carried to the lungs as emboli) and produces dramatic clinical symptoms of pulmonary embolism. This is a common cause of death among mothers who die suddenly during labor.

b. Assessment for Amniotic Fluid Embolism.

Amniotic fluid embolism is characterized by sudden dyspnea, chest pain, tachycardia, hypotension, and typical bluish, gray seen in patients with a pulmonary embolism. Death may occur within minutes without immediate intervention. Death may be maternal or fetal.

c. Medical and Nursing Interventions for Amniotic Fluid Embolism.

(1) Give immediate and vigorous treatment.

(2) Give oxygen by face mask.

(3) Maintain normal blood volume through administration of plasma and intravenous fluids.

(4) Prevent development of disseminated intravascular coagulation (DIC). Serious complications can occur.

(5) Administer whole blood and fibrinogen.

(6) Monitor the patient’s vital signs.

(7) Deliver the fetus as soon as possible.

NOTE: Disseminated intravascular coagulation is an acute abnormal stimulation of the normal coagulation process. The normal clotting process is a balance between clot formation and dissolution. In DIC, the balance is disrupted. The abnormal stimulation of coagulation results in widespread thrombi formation that eventually exhausts clotting factors and platelets and activates the process that dissolves fibrogen. Major bleeding results.