Table 4.
Monitoring and treatment of amniotic fluid embolism.
| Monitoring | Remarks |
|---|---|
| Foetal well-being (cardiotocography) | During antepartum AFE, for evidence of foetal distress and decision of when to deliver in a viable pregnancy |
| Pulse oximetry | Instant information on pulse rate and oxygen saturation to guide treatment, goal to maintain reading at 94–98% |
| Blood pressure | Allow detection and guide treatment of hypotension, to maintain mean arterial pressure around 65 mmHg |
| Blood count and coagulation test, fibrinogen level | Maintaining platelet count >50,000/mm3, normal INR and aPTT, fibrinogen ≥2.0 g/L |
| Blood glucose | Maintain at 7.8–10.0 mmol/L (140–180 mg/dL) |
| Arterial pH and blood gases | To look out for hypoxia, acidosis, and hypercapnia |
| Temperature | Maintain at 32–36 °C, especially after cardiac arrest |
| Treatment | |
| Norepinephrine | Maintain blood pressure and coronary perfusion pressure |
| Inotropes (dobutamine, milrinone) | Treatment of heart failure, improve ventricular contractility, maintain pulmonary vasodilation |
| NO, prostacyclin, sildenafil | Reduce pulmonary afterload |
| Fluid resuscitation, diuretics | Avoid overload, remove excessive fluid |
| Transfusion of blood products | Replenish lost blood, correct coagulopathy, giving packed red blood cells, fresh frozen plasma, and platelets at the ratio of 1:1:1 |
| Cardiac defibrillation | In case of asystole, ventricular fibrillation, etc. |
| Mechanical ventilation | Non-invasive or endotracheal intubation for pulmonary oedema |
| ECMO | Successful cases reported but risk of bleeding due to need for anticoagulation during ECMO |
| Prevention and treatment of postpartum haemorrhage | Oxytocic agents, repair lacerations, uterine tamponade and brace sutures, hysterectomy as last resort |
Abbreviations: ECMO = extracorporeal membrane oxygenation, INR = international normalized ratio, aPTT = activated partial thromboplastin time, NO = nitric oxide.