Pregnancy is usually a time of hope and dreams; dreams of giving
birth to a beautiful baby, and dreams of becoming a mother. However not
all dreams come true, and they can be shattered by unexpected
complications of childbirth. This presentation will relay the story of
one woman's amazing tale of survival of an amniotic fluid embolism.
Amniotic fluid embolism (AFE) is a rare and potentially fatal
complication in pregnancy, occurring in 1 in 8000 to 80,000 pregnancies
in the US (Clark, et al 1995, Schoening, 2006)). The odds of survival
are low (20%), and the odds of surviving neurologically intact are even
lower (15%). Multiple disciplines rallied together to make one woman's
story have the happy ending that we expect when a woman comes to the
hospital to deliver a baby. Mother & baby went home from the hospital-
together - just like in the dream.
The current theory about amniotic fluid embolism syndrome is that
it is an anaphylactic response to amniotic fluid in the maternal
circulation. There is no way to prevent this condition, nor predict who
will develop this condition. Historically, it was postulated that
amniotic fluid, containing fetal material, (squamous cells & hair)
entered in the maternal circulation and formed an embolus, which
obstructed the pulmonary vasculature, causing a severe systemic reaction
similar to shock and anaphylaxis. More recent studies have shown that
fetal elements were not always present in the maternal circulation of
women who developed AFE. In contrast, evidence of amniotic fluid has
been found in women who have not developed the condition. The idea of an
anaphylactic reaction is supported by the findings that women carrying a
male fetus and women who have a history of allergy are associated with
this condition. The clinical presentation of this condition is typically
one of sudden cardiovascular collapse, respiratory distress, shock and
coagulapathy which usually occur during labor or within the first 30
minutes after delivery (Moore, 2005). Through this case presentation,
the associated pathophysiology, clinical manifestations and treatment of
amniotic fluid embolism will be outlined. As a result of a
multidisciplinary team effort, that blended the diverse knowledge and
expertise of nurses, obstetricians, anesthesia personnel, blood bank
technicians, and trauma surgeons, two lives were saved, and a dream came
true. This case study demonstrates how the many voices that care for
women and newborns work together as partners to optimize health
outcomes.