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Anaphylactic syndrome of pregnancy

Extracted from Mayes Midwifery 14th Edition, Sue Macdonald & Julia Magill-Cuerden (Eds). Baillière Tindall, 2011. Courtesy Elsevier

This rare but potentially catastrophic condition occurs when amniotic fluid enters the maternal pulmonary circulation via the uterus or placental site. The presence of amniotic fluid triggers an anaphylactoid response. Although also known as amniotic fluid embolism, the term embolus is a misnomer. The body responds in two phases:

  • The initial phase is one of pulmonary vasospasm causing hypoxia
  • The second phase sees the development of left ventricular failure, with haemorrhage, coagulation disorder and further uncontrollable haemorrhage

Amniotic fluid embolism can occur at any time but during labour and its immediate aftermath is most common. It should be suspected in cases of sudden collapse or incontrollable bleeding. Maternal and fetal/neonatal mortality and morbidity are high, however, with immediate resuscitation in a well-equipped hospital, it is no longer the universally fatal condition of the past. Management is with resuscitation (ABC - airways, bleeding, circulation), immediate management of coagulopathy, aggressive treatment of uterine atony with oxytocics, ergometrine and prostaglandins, and adjunctive techniques, e.g. packing, tamponade or Rusch balloons. If bleeding cannot be controlled, emergency hysterectomy is indicated and may be life-saving.

Resources

UK Resuscitation Council http://www.resus.org.uk

Anaphylaxis Campaign Helpline 01252 542029 http://www.anaphylaxis.org.uk

Jacqueline Payne (2015). Amniotic fluid embolism (Professional reference) http://patient.info/doctor/amniotic-fluid-embolism

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