Haemorrhage during delivery, retained placenta, fetal distress … Some pregnant women may experience several complications during childbirth. Among the latter, we also find amniotic embolism. This accident was first described in 1926 by JR Meyer. This poorly understood complication occurs during labor, at the time of childbirth or during delivery. In France, it would represent the fourth cause of maternal obstetric mortality, according to the National Committee of Experts on Maternal Mortality (CNEMM).
Amniotic embolism: what is it?
Amniotic embolism is a rare and unpredictable event that occurs when amniotic fluid passes into the mother-to-be's bloodstream during childbirth. This passage of amniotic fluid can occur through the placental veins or during tears in the lower segment of the uterus or cervix.
Amniotic fluid contains squamous epithelial cells, hair, fatty elements, mucus, bile, and sometimes meconium. During the passage of amniotic fluid into the maternal circulation, all these fetal cells will migrate into the lungs of the pregnant woman and will obstruct the pulmonary arteries of the mother-to-be. This can lead to acute respiratory distress, cardiac arrest, and disseminated intravascular coagulation (DIC).
Amniotic embolism: what are the causes?
Several risk factors are associated with a risk of amniotic embolism. Among them, we find:
What are the symptoms of an amniotic embolism?
This complication of childbirth usually manifests itself during and shortly after labor and delivery. It translates into:
How do you diagnose an amniotic embolism?
The diagnosis of amniotic embolism is based on physical examination. This complication is suspected when three symptoms occur: hypotension, bleeding disorders and hypoxia, ie insufficient oxygen delivered to organs.
Another way to detect amniotic embolism is to exclude other causes. The medical team is trying to find out if the cardiac arrest is caused by congenital heart disease, for example, or if the acute respiratory failure is due to pulmonary embolism.
An autopsy can also show fetal cells in the maternal pulmonary circulation.
Amniotic embolism: what are the treatments?
The management of amniotic embolism is primarily symptomatic. Treatment focuses on the control of organ failure responsible for mortality. A transfusion of red blood cells and plasma is necessary to compensate for the blood loss. In the event of respiratory failure, cardiopulmonary resuscitation is also necessary. If the pregnant woman has not yet given birth, the medical team should have an emergency caesarean section.
Sources: the National College of French Gynecologists and Obstetricians (CNGOF), Birth Security Network, MSD Manual
Read also :
⋙ What are the possible complications during childbirth?
⋙ Retroplacental hematoma: what is this serious complication that can occur during pregnancy?
⋙ Pregnancy hyperemesis: how to recognize and treat this complication of pregnancy?