The most dangerous emergency that can occur to an expectant mother (Amniotic Fluid Embolism)

Pregnancy is a very beautiful and hopeful time in a mother's life. But at the same time, things like fears and doubts also come to mind. Especially when the baby is about to be born, the question "Will everything be okay?" is in the back of your mind. Today we are going to talk about a very rare, but also very dangerous emergency that can occur during pregnancy. Don't be scared when you hear this, because this is something so rare that it doesn't happen to even one in a thousand. But it is very important to be aware of this.

Simply put, what is amniotic fluid embolism (AFE)?

The name may sound a bit complicated, but let's keep it simple. You know, when your baby is inside the womb, there's a liquidy fluid surrounding him. We call this amniotic fluid . This acts like a protective cushion for your baby. This fluid contains not only water, but also cells that are shed from your baby's skin, fine hairs, and other things.

Normally, when the baby is born, some of this amniotic fluid can enter the mother's circulatory system, that is, her blood. This is very normal and does not cause any problems for most mothers.

But, unfortunately, when this amniotic fluid enters the bloodstream, some mothers' bodies have a very severe allergic reaction, or allergic response. In other words, the body thinks that a big enemy has entered the body. The emergency caused by this severe reaction is called amniotic fluid embolism (AFE) . Sometimes this is also called anaphylactic syndrome of pregnancy .

This response can cause the heart and lungs to suddenly stop working. This means that the rest of the body's organs are deprived of oxygenated blood. This can lead to serious conditions such as cardiac arrest. Not only that, but it can also cause uncontrollable bleeding from the uterus or from a caesarean section wound.

How common is this AFE condition? Is it something to be worried about?

No. You don't need to worry too much about this. Because this is very rare . In a country like America, this condition is reported in only one out of 40,000 births. That means if about 300,000 children are born in Sri Lanka every year, this condition is reported in only 7-8 people at most. So don't worry unnecessarily about your pregnancy.

The problem is that the symptoms of AFE are very similar to those of other serious conditions that can occur during pregnancy, such as placental abruption, uterine rupture, or eclampsia. So it can be difficult to pinpoint the exact cause.

What factors increase the risk of this condition occurring?

Because it is so rare, and because it is not yet known exactly why only some people develop this reaction, it is difficult to say exactly what the risk factors are. However, research has shown that certain factors may slightly increase the risk. However, it is important to remember that not everyone with these factors will develop AFE.

What are the symptoms of AFE?

The most dangerous thing about this is that the symptoms appear suddenly and very quickly . A mother may suddenly start behaving abnormally, either while the baby is about to be born or immediately after it is born.

What complications can occur due to this condition?

AFE is a condition that can cause very serious complications for both mother and baby.

Complications that may occur in the mother

• Heart and lung failure.
• Loss of consciousness.
• Seizures.
• Excessive bleeding.
• Disseminated Intravascular Coagulation (DIC) is a condition in which the body's blood clotting system is disrupted, causing blood clots to form unnecessarily on one side and uncontrolled bleeding on the other.
• Stroke.
• Cardiac arrest.
• Brain damage.
• Unfortunately, even death can occur.

Possible complications for the baby

The impact on the baby will vary depending on when this condition occurs in the mother. If this occurs before the baby is born, emergency surgery will be required to remove the baby immediately.

The biggest risk for babies born after the onset of AFE is lack of oxygen . As the mother's body fails, the baby loses oxygen supply. This lack of oxygen can damage the baby's nervous system or brain.

How do doctors diagnose and treat this?

Since this is an emergency, there is no time to do blood tests or scans to make a diagnosis. Doctors suspect AFE by looking at the symptoms and quickly ruling out other causes (e.g., excessive bleeding, heart attack).

This situation is usually said to occur in two stages:

1. Stage 1: This is when the respiratory system and heart suddenly stop working. This means you can't breathe and your heart stops. The highest number of deaths are reported in this stage.

2. Stage 2: This is the stage where bleeding occurs. If life is saved in the first stage, the next stage is uncontrollable bleeding.

Treatment methods

Because this is an emergency, the medical team must work very quickly to save both mother and baby. The treatment team includes many people, such as gynecologists, anesthesiologists, intensive care unit doctors, and nursing staff.

The main treatments are:

• Delivering the baby immediately: If the baby is still in the uterus, a cesarean section will be performed as soon as possible to remove the baby.
• Providing oxygen: Because breathing is difficult, a tube is inserted and connected to an artificial respirator (mechanical ventilation).
• Cardiac support: If the heart stops, chest compressions (CPR) are administered. Medication is given to control blood pressure.
• Blood transfusion: Due to excessive bleeding, large amounts of blood, plasma, and platelets must be given.
• Hysterectomy: Sometimes, if the bleeding cannot be stopped, a hysterectomy may be performed as a last resort to save the mother's life.

All of this happens in an intensive care unit (ICU) or operating room.

If you survive this condition, are there any long-term effects?

The survival rate for AFE is unfortunately low, with some studies suggesting that the mortality rate may be as high as 60%.

However, mothers who survive this horrific condition may experience some long-term effects, depending on the extent of the damage to the body.

• Physical effects: Permanent damage to the heart, effects on the kidneys, complications due to paralysis.
• Effects on the nervous system: Lack of oxygen to the brain can affect things like memory and the ability to recall words.
• Psychological effects: This is very important. After a near-death experience like this, it is very common to experience psychological problems such as severe shock, anxiety, depression, and post-traumatic stress disorder (PTSD) . Some people may even feel guilty, thinking things like, "Why did this happen to me?"

Is there a way to prevent this?

Unfortunately, the answer is "no." Doctors still don't know why only some people have such a severe reaction, so there's no way to prevent AFE .

So what can we do?

The best thing we can do is be prepared for any emergency. That means talking to your doctor before you give birth and learning how the hospital's medical team will handle an emergency.

Think about your birth plan . It's a plan for the most beautiful birth you can hope for. But remember, in an emergency, the medical team will have to go beyond that plan and do whatever is necessary to save you and your baby. At that time, it's important to trust the medical team .