Amniotic Fluid Embolism- Making It E.A.S.Y. (Early Recognition, Action Now, Stay Ahead, You Did It!)

Background:

Amniotic Fluid Embolism (AFE) is a rare obstetrical event with devastating outcomes.  Prediction and diagnosis of the event is nearly impossible.  However, timely recognition and response is critical in saving a woman’s life.  The majority of patients experiencing an AFE do not survive. 

The purpose of this presentation will be to provide the practicing clinician with the tools necessary to recognize a suspected AFE event, to respond swiftly and appropriately, and to function as a team lead in this life threatening situation.  To accomplish this, we will review the signs and symptoms of an AFE, focusing on recognition of subtle changes in vital signs and patient status.  Next, we will discuss the recommended management of a patient experiencing an AFE, focusing on anticipating clinical needs and the role of nurse as team lead during the event.  Finally, we will conclude with a discussion of the impact of devastating clinical situations, such as an AFE, on the team.  We will discuss the role of nursing leadership in facilitating debriefing and support sessions for the team. 

Case:

We will chronicle the story of Ms. F, a low risk labor and delivery patient whose clinical picture rapidly deteriorated as she began to display the subtle signs of an AFE.  Ms. F developed severe hypotension and acute respiratory distress following rupture of an amniotic membrane forebag.  Ms. F recovered from this event and delivered rapidly.  Following delivery, Ms. F began to hemorrhage and developed disseminated intravascular coagulation (DIC).  Lab values post delivery displayed classic signs of DIC including:  Fibrinogen <60; Antithrombin III level of 68; significant decreases in Hemoglobin, Hematocrit and Platelet values; and a positive D-dimer.  The patient was managed through our Code White (hemorrhage) response system and an interdisciplinary team from throughout the hospital worked for hours to save Ms. F’s life.  Ms. F’s recovery was guarded, yet remarkably rapid.  Ms. F walked out of the hospital a mere 2 weeks after her delivery in good general health and with only minor memory losses. 

Conclusion:

In summary, we will detail our learnings from this incredible case of AFE, including the following implications for nursing practice:  Have a high degree of suspicion and don’t waste time; A team response is essential as every person will be needed; Stay a step ahead and be prepared; Provide emotional support for the team after the incident.

Keywords: Amniotic fluid embolism, Disseminated Intravascular Coagulation, Debriefing