Amniotic Embolism – An Unexpected Trauma

April 8, 2012 by  
Filed under Acute Hospital Care

An Amniotic Fluid Embolism (AFE) is an obstetric disorder in which amniotic fluid or other debris enters the mother’s bloodstream.  This trauma generally happens in the hospital right before the baby is to be delivered.

The bloodstream is typically made up of a mixture of red and white blood cells, platelets.  While the exact ratio of these cells may vary, an invasion of foreign material into the blood causes severe and unforgiving trauma.

The easiest way to understand an amniotic fluid embolism is to imagine a rupture in the uterine wall.  This rupture can be likened to a dam breaking as the pressurized fluid inside the uterus is forced out through the ruptured area.  Amniotic fluid and other foreign material flood the bloodstream, moving from the higher pressure of the uterus into the (comparatively) lower pressure bloodstream.  Once amniotic fluid escapes the uterus, it advances through mom’s arteries and veins and throughout her body.  In seconds, this rush of foreign matter spreads widely and inhibits the blood from doing its job properly.

Imagine adding half a tank of water to the gasoline in the lawnmower.  A tug on the cord causes the machine to cough and wheeze.  Cutting the grass is now an exercise in futility.  The mower will not work… it has lost its utility.  Water has corrupted the gasoline and prevented it from allowing the mower to function properly.

The flood of amniotic fluid into the bloodstream is much like a large volume of water in a mower’s gas tank.  The blood reacts by going into its version of shock:  disseminated intravascular coagulation (DIC).

DIC is a condition where the blood becomes abnormally active.  It reacts to the trauma by using up proteins in an all-out war of massive clotting.  This clotting may lead to irregular blood flow to arms, legs, and vital organs.  It may also lead to stroke.  Once the proteins are used up, the pendulum swings the other way as the blood is unable to clot any more.  Excessive bleeding follows, putting the patient at risk for bleeding out.

The real danger of an amniotic fluid embolism is damage that ensues after the body goes to war with itself.  The blood fails to work properly, causing the brain and heart to shut down.  Organs break down and vital signs begin to fail.  The minutes that follow determine if the patient will even have a chance at survival.

For medical insiders, DIC is known by its street name “death is coming.”  From this point forward, recovery is the longest of longshots.  Improvement requires replacing all the corrupted blood with new blood that allows the body to function.  Simply surviving may require dozens of blood transfusions and days to allow the body to stabilize.  Getting out of this situation alive requires advanced medical care and a strong will to live.

The massive failure of mom’s bloodstream and organs results in a loss of consciousness.  There are now two lives at stake:  mom and baby.  An emergency c-section allows baby to escape danger.  As a result, baby is more likely to survive and go on to lead a normal life.

A cesarean section requires cutting open mom’s belly, but a large incision is the last thing that could help mom overcome her DIC.  The blood is already corrupted and the body now has a brand new trauma to deal with.  Once baby is safely out, mom’s life is even further in doubt due to the following two realities:

  • Large new incision (the c-section)
  • Corrupted blood

Ask any mother and she will tell you that a c-section can cause pain and discomfort in the days and weeks after delivery.  After an amniotic embolism, the additional trauma of a cesarean section is magnified.  The blood’s fluctuating ability to clot makes this new incision an unhelpful variable in the healing process.  If there were a way to get the baby out quickly without cutting the mother, life would be just a little less tenuous right now.

The additional trauma magnifies mom’s distressed condition.  Recovery from a severe case of DIC is about as likely as an eight year old finishing a (26.2 mile) marathon.  The additional trauma is like that same eight year old finishing the race one week after breaking his arm.

Although survival is unlikely, it is possible.  As this trauma is quite rare, the medical profession has only recently been compiling AFE statistics.  The incidence of amniotic fluid embolism has been projected at 1 in every 10,000-25,000 patients.

The true statistics, however, are thought to be underreported due to misdiagnosis and the inconsistent reporting of cases that do not end in death.  It may be slightly more common than even these number suggests.

About half of mothers die in the first hour from the initial cardiac and respiratory trauma.  Those that live have varying degrees of amniotic fluid in their bloodstream.  If the initial trauma was a slow leak, then the blood may retain its function and mom will have a good chance of recovery.  If trauma was a rupture or large leak, then the blood will be corrupted and recovery much less likely.

Most mothers (as many as 80%) do not live through this trauma.  Of those that survive, many live the rest of their lives with permanent physical and neurological damage.  Worst case scenario, mom is never able to come out of the coma.  Best case, mom had a smaller leak and the blood is able to close the leak with a clot.

In the best case scenario, mom may end up with a big wake-up call on the importance of life.  She may present with little to no residual damage.

The other party in this trauma is baby.  Once mom’s blood is corrupted, baby’ life is in imminent danger.  Unborn babies eat and breath through the mother.  Any trauma in the mother is magnified for the baby.  In cases where the baby is removed quickly, the chance of life is excellent.  Approximately 80% of babies survive the AFE experience.  The hospital generally places these babies in a neonatal ICU, for they often have lingering symptoms.  In some cases, the baby may sustain permanent damage and have long lasting medical problems.

No matter what the result, an amniotic fluid embolism is a life-changing event for the family.  It is an event that tests the mettle of even the strongest husbands and the most well-adjusted kids.  The unexpected nature of this health emergency affects all family members.  If the end result is a bad one, regret and anger often follow.  The psychological damage can be a long-lasting problem for the family and friends of the patient(s).

The emotional and financial stress that follow a major health incident can rip a family apart.  These stressors can cause the family to implode.  They can cause family members to lash out each other, God, and anyone else in their sphere of influence.

The purpose of this website is to help you stay positive to give yourself (or your loved one) the best chance at the best possible recovery.  The life that you had before may be gone forever, but that doesn’t mean that life is over.  Getting used to your new life takes incredible effort.  Keeping your sanity may require big changes in all areas of life.

Going forward, life may never again be “perfect.”  For your sake, make sure that you do everything in your power to make sure that life is “good.”

More information about amniotic fluid embolism (and other related topics) can be found by clicking the links below.

 

Related Articles

 

 

References:

  • wikipedia.org – amniotic fluid embolism, coagulopathy
  • medscape.com – amniotic fluid embolism

 

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Comments

2 Responses to “Amniotic Embolism – An Unexpected Trauma”
  1. Alicia says:

    I survived an AFE and DIC. Very nice description. Very scary. A coma for 2 1/2 weeks. Daughter was born at 29 weeks.I had sever preclamcia, emergency csection, could feel my doctor cutting me open she said I would have to be put to sleep, I said no
    My daughter and husband went to the nicu then 20 mins later coded. I have sever damage, cant sit or stand for long times. Im on strong pain meds just to move around. Daughter is 3 1/2 now and as wild and happy as any normal child. Thanks again for the article.

  2. Holly says:

    I survived an AFE and DIC in January 2015. I coded 4 times each time resuscitation was successful though I would code again…. the last time they really shocked my heart and said I needed to stay here …well here I am mother of 4. Two handsome boys and two beautiful divas. The twins were delivered via c-section at 34 weeks, we believe my history of clotting could have been a factor. I took baby aspirin and prescription anticoagulant drugs which I now take due to having a blood clot in my leg almost 2 yrs post op.
    My daughters were 7 weeks early but on track with everything for their age. They are now 2 yrs 3 months old and very much thriving! I suffer memory loss ,which for the longest I couldn’t remember much of anything like my brain shut off during that time but to my surprise I started remembering somethings and actually retained it. So hopefully that means my short term memory issue is or has corrected itself.

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