The contact of amniotic fluid in the bloodstream of the mother during labor is called embolism. This is a dangerous obstetric pathology that can lead to the death of the mother and fetus, also called amniotic embolism or thromboembolism.
Causes of embolism with amniotic fluid
The entering of amniotic fluid into large vessels and the pulmonary artery is possible because of:
- rupture of the cervix during childbirth or the uterus itself;
- cesarean section;
- anomalies in the development of shells;
- communication between the vascular and amniotic channels of the mother.
The factors provoking this pathology are:
- placenta previa;
- poor-quality study of amniotic fluid;
- early placental abruption, which is preceded by amniotic fluid with blood;
- increased pressure in the uterus with polyhydramnios, multiple pregnancy, discoordination, rough labor.
Pathogenesis of embolism by amniotic fluid
Meconium, damp grease, skin cells, placenta, umbilical cord and amniotic fluid through damaged vessels enter large arteries. Soon they find themselves in the right atrium and pulmonary artery. Most often, such complications occur at the end of birth. Dangerous moments arise a lot:
- foreign bodies cause anaphylactic reaction or even anaphylactic shock ;
- elements of water, acting as a fat embol, disrupt the functioning of the circulatory system;
- amniotic fluid increases blood coagulability, which leads to disseminated intravascular coagulation.
Clinical manifestations directly depend on:
- mechanism and causes of water ingress;
- the volume of water trapped in the blood;
- immune features of a woman;
- the period of childbirth;
- concomitant pathology.
Symptoms and varieties of embolism with amniotic fluid
The typical clinical symptoms of the disease are the following:
- dyspnea;
- a sense of fear, suffocation;
- pain behind the sternum;
- increased body temperature;
- the appearance of chills;
- cough;
- dizziness and weakness;
- private, but weak pulse;
- pronounced cyanosis of the upper chest and face;
- loss of consciousness.
Depending on the symptoms, obstetricians distinguish several forms of amniotic embolism:
- collaptoid;
- convulsive;
- edematous;
- hemorrhagic;
- lightning fast, which is characterized by a rapid current.
Diagnosis of thromboembolism with amniotic fluid
Diagnosis of pathology usually includes:
- conducting an electrocardiographic (ECG) study capable of detecting pronounced sinus tachycardia, an acute pulmonary heart, hypoxia of the myocardium;
- carrying a chest x-ray to detect interstitial swelling that resembles a butterfly's wings;
- blood tests.
Treatment of embolism with amniotic fluid
Assistance in detecting amniotic embolism includes:
- normalization of breathing;
- shock stop;
- prevention and prompt treatment of hemorrhagic complications;
- carrying out the necessary operations.
Emergency therapy consists of intravenous administration of dimedrol, promedol, diazepam, antispasmodics, cardiac glycosides and corticosteroids under the constant supervision of diuresis, CVP, AD, ECG, CBS, hematocrit and electrolyte balance. After carrying out the aforementioned urgent measures, a cautious but rapid cesarean section is recommended. If the embolism develops in the second stage of labor, use obstetric forceps. The contact of amniotic fluid in pregnant women in the bloodstream is the main cause of childbirth. For this reason, prevention of embolism is very important, which is carried out together with a coagulologist using means to influence the coagulation system.