![]() This magical material has interesting physicochemical properties and a complex composition, largely consiting of: The amniotic fluid is slimy, yellowish white or pale yellow, and cloudy like soap water (rarely clear) it almost always contains much mucous flocks and has a peculiar odor. A sopering realism is introduced by Doke Uyeno (1919) who described its properties in horriic detail. Now, amniotic fluid is not some sort of crystal-clear mountain stream straight from some sanitised fairytale description of pregnancy. Amniotic fluid will very likely choose a path of least resistance, and funnel massively into the inferior vena cava. Imagine then if the uterus contracts while the uterine blood vessels are open. Amniotic fluid pressure during pregnancy is usually positive anyway (5-10mmHg). In labour, it can increase substantialy with uterine contractions. Ergo, occasionally during particularly deep inspiration the venous pressure may become negative (due to extremely negative intrathoracic pressure) entraining amniotic fluid through those breahed venules. This is exacerbated by the deep breaths characteristic of labour. Negative venous pressure: venous blood returns to the heart, and therefore there is a constant flow through this side of the circulation.Amniotic fluid will get into the venous circulation though this opening by a variety of mechanisms: Let's say that there is some sort of direct venous blood/amniotic fluid interface, at the breach of some venous blood vessel somewhere in the uterus. open wound on the uterus, such as a Caesarian incision) Other associated features are listed by Moore et al (2005):ĭifferentials are also offered by the same article, which is helpful:Īmniotic fluid gains access to the circultaion by a number of possible routes: The hypoxia hypotension and DIC are what you migth call "cardinal signs". This list likely represents the maximum expected of a candidate. The British AFE Register ( Tuffnell et al, 2005) used something very similar to identify cases for record-keeping purposes. Non-specific symptoms – chills, nausea, vomiting, agitation. ![]() The onset of the symptoms and signs of amniotic fluid embolism syndrome (AFES) most commonly occurs during labour and delivery, or immediately postpartum.The college answer listed the following features, making them canonically "important": ![]() Question 28 from the first paper of 2017 asked the candidates to outline the important clinical features of amniotic fluid embolism. Clinical features amniotic fluid embolism That would probably be enought to satisfy the requirements of the time-poor exam candidate who does not wish to pay UpToDate subscription fees. Potentially, vicious viva scenarios may in the future ask the candidates to make an echo diagnosis, or to manage the situation (which may or may not progress to cardiac arrest).Īs far as published literature goes, one cannot go past Moore's article from Critical Care Medicine (2005). The question specifically asked for clinical features and risk factors. ![]() Though Question 28 from the first paper of 2017 was the first time the college had asked for some detail about this condition, it comes up now and again as a differential in the lists of possible reasons for DIC (for example), or sudden peri-Caesarian cardiovascular catastrophe, or possibly as a part of a particularly vicious viva station. Death occurs typically due to circulatory collapse, or (if that doesn't get you) respiratory failure and severe hypoxia. Clearly that was an abnormal finding, but nobody really put two and tow together until a whole case series of sudden maternal deaths was linked to pulmonary embolism of amniotic fluid by Steiner and Lushbaugh (1941). It was discovered for the first time by Ricardo Juvenal Meyer in 1926, who was extremely surprised to find whole chunks of foetal tissue (skin cell, lanugo hairs, intestinal mucin) in the pulmonary vessels of dead mothers. Amniotic fluid embolism occurs when some amniotic fluid gains access to the maternal circulation, often in massive volumes and with catastrophic consequences. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |