Amniotic fluid embolism: how high is the risk really?

An amniotic fluid embolism during childbirth can be life-threatening for the mother giving birth. Fortunately, however, it is very rare. We will explain to you here which risk actually exists during childbirth and which factors play a role.

Being afraid of an amniotic fluid embolism is understandable, after all it is anything but harmless. But right at the beginning of this article we would like to take away your fear a little: an amniotic fluid embolism is very rare!

Education is important precisely because many pregnant women worry and fear about an amniotic fluid embolism. Therefore, in this article we will give you answers to the following questions, among others: What is an amniotic fluid embolism? What are the causes and risk factors? What is done in the event of an amniotic fluid embolism?

What is an amniotic fluid embolism?

An amniotic fluid embolism (FWE), also known as amniotic infusion syndrome, can occur if amniotic fluid gets into the bloodstream and thus also into the pulmonary circulation of the woman giving birth during or after birth. As a result, the blood vessels close, which means that parts of the body are no longer supplied with sufficient blood. In addition, the lungs no longer supply sufficient oxygen. Therefore, the amniotic fluid embolism is also considered a special form of pulmonary embolism.

This birth complication is unpredictable and can be life-threatening. The chance of an amniotic fluid embolism is about two to eight in 100,000. It is essential to the survival of mother and child that FWE is diagnosed as soon as possible and that immediate action is taken.

When does an amniotic fluid embolism occur?

The treacherous thing about FWE is that it is unpredictable. Your gynecologist will therefore not be able to detect any early signs of an amniotic fluid embolism during pregnancy.

AWE can only occur when a blood vessel in the cervix, in the uterine muscles, or between the placenta and the uterus is injured, or there is a  rupture of the uterus (tearing of the uterus)  . Only then is there a risk of amniotic fluid penetrating the circulatory system of the woman giving birth. Therefore, an amniotic fluid embolism also occurs more frequently during or after birth.

During pregnancy, there is a risk of such an injury only if the pregnancy has been terminated or if there has been abdominal trauma. The latter can occur after external violence, such as an accident or a fall.

Risk factors and causes

There is only a risk of an amniotic fluid embolism if a pregnant or child-bearing woman is injured in or on the uterus. This is a circumstance that very rarely occurs. However, there are certain risk factors that can lead to this. For example if:

  • suction cup or forceps is used.
  • the amniotic sac bursts prematurely .
  • the woman giving birth is older than 35 years, i.e. there is a high-risk pregnancy .
  • it is a multiple birth.
  • the birth is medically induced .
  • polyhydramnios is diagnosed in the pregnant  woman.
  • the pregnant  woman has eclampsia .
  • cesarean section is performed.
  • the placenta detaches prematurely.

The list may seem long to you, but in fact, doctors and researchers are not 100 percent sure what causes and risk factors actually lead to FWE. The above points are therefore considered possible risk factors and causes.

symptoms

An amniotic fluid embolism occurs in two phases. First, the affected person suffers a cardiogenic shock due to the interrupted oxygen and blood supply. The lack of oxygen leads to liver and kidney failure, coma and convulsions in the second phase. Both phases can be life-threatening or result in permanent damage.

Doctors can recognize AFE by the following symptoms, all of which occur suddenly in the parturient, pregnant woman or mother:

  • shortness of breath
  • bluish discoloration of the mucous membranes
  • fear
  • restlessness
  • confusion
  • loss of consciousness
  • cramps
  • Vomit
  • chills

What is done in the event of an amniotic fluid embolism?

Since an amniotic fluid embolism is unpredictable even for experienced doctors and occurs very rarely, intensive medical measures must be initiated as soon as possible to save the life of the mother and, if necessary, that of the child if it happens during childbirth. Because after the occurrence of an FWE, every second counts.

The focus is on stabilizing women. In most cases, intubation is required to restore adequate oxygen. Blood transfusions are also usually necessary. If such an embolism occurs during childbirth, the baby should first be brought into the world as quickly as possible and ideally vaginally. It must then be ascertained whether – and if so, to what extent – the baby was affected by the FWE.

How can you prevent an amniotic fluid embolism?

Since an amniotic fluid embolism occurs suddenly, there is basically nothing you can do to prevent it. The only thing you can do is keep reminding yourself that FWE is really rare and the risk for you is basically low.

We therefore recommend the following:

  • Talk openly to your doctor or midwife about your worries and fears. They will assure you that an FWE is not something you really need to worry about. In this way, you can eliminate any remaining doubts during a conversation.
  • Enjoy your pregnancy! Because this is the best thing you can do for yourself and your baby! 🙂

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