AMNIOTIC FLUID

EMBOLISM

BY-HIMANSHU
AMNIOTIC FLUID EMBOLISM
● This is the most serious, unpredictable and unpreventable cause of
maternal mortality.
● During labour and in the immediate postpartum period, the contents of
amniotic fluid may enter the uterine veins and reach right side of the
heart resulting in fatal complications.
● The amniotic fluid components which may be found in uterine veins,
pulmonary artery and vessels of other organs are: epithelial squames,
vernix caseosa, lanugo hair, bile from meconium, and mucus.
● These amniotic fluid contents gain entry either through tears in the
myometrium and endocervix, or due to vigorous uterine contractions the
amniotic fluid is forced into uterine sinusoids.
MORPHOLOGIC FEATURES
● Notable changes are seen in the lungs such as
○ haemorrhages,
○ congestion,
○ oedema
○ changes of ARDS
○ dilatation of right side of the heart.
● These changes are associated with identifiable
amniotic fluid contents within the pulmonary
microcirculation.
CHARACTERISTIC FEATURES
The clinical syndrome of amniotic fluid embolism is
characterised by the following features:
i) Sudden respiratory distress and dyspnoea
ii) Deep cyanosis
iii) Cardiovascular shock
iv) Convulsions
v) Coma
vi) Unexpected death
CAUSE OF DEATH
● The cause of death may not be obvious but can occur as
a result of the following mechanisms:
i) Mechanical blockage of the pulmonary circulation in
extensive embolism.
ii) Anaphylactoid reaction to amniotic fluid components.
iii) Disseminated intravascular coagulation (DIC) due to
liberation of thromboplastin by amniotic fluid.
iv) Haemorrhagic manifestations due to thrombocytopenia
and afibrinogenaemia
MEDICOLEGAL IMPORTANCE
● Maternal and Fetal Death Investigations: When AFE results in
maternal death, forensic experts may conduct a thorough investigation
to determine the cause, contributing factors, and potential medical
negligence or malpractice.
● Legal Considerations: AFE may have legal implications, especially if
medical negligence or malpractice is suspected. Forensic experts may
be involved in providing expert opinions and testimony in legal
proceedings.
● Legal Considerations: AFE may have legal implications, especially if
medical negligence or malpractice is suspected. Forensic experts may
be involved in providing expert opinions and testimony in legal
proceedings.
MEDICOLEGAL IMPORTANCE (CONINUED:

● Risk Factors: Identification of risk factors associated with AFE, such as

advanced maternal age, multiparity, or induction of labor, can be
important in forensic investigations to assess potential preventable
causes.
● Awareness and Education: Forensic experts may contribute to raising
awareness about AFE among healthcare professionals, encouraging
appropriate prevention, identification, and management of this condition.
● Research and Prevention: Continued research into the causes, risk
factors, and prevention strategies related to AFE is crucial for forensic
experts to provide evidence-based opinions and recommendations in legal
cases involving AFE.
THANK YOU