Amniotic fluid embolus

• An uncommon but dangerous complication of childbirth.

• There is a high early mortality associated with acute pulmonary hypertension.

• The initial response of the pulmonary vasculature to the presence of amniotic fluid is intense vasospasm resulting in severe pulmonary hypertension and hypoxaemia.

• Right heart function is initially compromised severely but returns to normal with a secondary phase during which there is severe left heart failure and pulmonary oedema.

• Amniotic fluid contains lipid-rich particulate material which stimulates a systemic inflammatory reaction. In this respect the progress of the condition is similar to other causes of multiple organ failure with associated capillary leak and disseminated intravascular coagulation.

• Diagnosis is supported by amniotic fluid and fetal cells in pulmonary artery blood and urine, though this finding is not specific for embolus.

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