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Amniotic fluid embolus is the eighth most common cause of all maternal deaths, down one place from the previous edition of this book [2, 5]. At 0.35 per 100 000 maternities (95% CI 0.15–1.39) it has declined from the fourth to the fifth leading cause of direct maternal deaths in the United Kingdom. Maternal case fatality rates are between 11% and 32% in the United Kingdom, Australia and the United States [9, 4, ref surveillance]. There is a fall in case mortality rates which is probably due to high-level supportive care and diagnosis of milder cases .
Women who died or who had permanent neurological injury were more likely to present with cardiac arrest (83% vs. 33%, P < 0.001), be from ethnic-minority groups (adjusted odds ratio [AOR] 2.85; 95% CI 1.02–8.00), to have had a hysterectomy (OR 2.49; 95% CI 1.02–6.06) and were less likely to receive cryoprecipitate (OR 0.30; 95% CI 0.11–0.80) .
There is little evidence base for pregnancy-specific management of endocrine crises, and in the majority of cases the underlying condition should be treated as it would be outside of pregnancy, with no need for immediate delivery. Thyroid storm is associated with an increased risk of preterm labor, and staff in the critical care setting should be aware of this, along with the signs and symptoms of labor. Myxedema coma is a challenge to diagnose because of its insidious onset and lack of classic signs and symptoms. Acute adrenal crisis in the pregnant patient, if left untreated, is associated with high risk of maternal and fetal mortality. If labor coincides with pituitary apoplexy, steroid administration and correction of electrolyte imbalances are essential. In pregnancy, diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) typically occur in the second and third trimesters, affecting an estimated 1-2 percentage of pregnancies.
This chapter discusses the maternal and fetal implications, diagnostic signs, and management strategies for amniotic fluid embolus (AFE). Pulmonary oedema, acute respiratory distress syndrome, disseminated intravascular coagulopathy (DIC), pulmonary embolus, haemorrhage, right then let cardiac failure, cerebrovascular events, cardiorespiratory arrest, death are maternal implications of AFE. The first-line management involves resuscitation strategies. The main aim of early delivery is to facilitate and improve outcome of maternal resuscitation. The second-line management includes diagnosis and supportive care. The purpose of ICU is to monitor observations, maintain haemodynamic instability and reduce iatrogenic and disease complications. Options of treatment include diuretics, inotropes and steroids. Plasma exchange, haemofiltration and extracorporeal membrane oxygenation have been used in treatment. Regular fire drills involving maternal collapse on the labour ward can ensure that a robust system is in place for the acute management of AFE.
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