**6.3 Coagulopathy**

Hemorrhage with DIC requires initiation of a massive transfusion protocol. Correcting the coagulopathy may require aggressive repletion of red blood cells and blood products, fresh frozen plasma, platelets, and/or cryoprecipitate. Consideration should be given to arterial catheterization if possible, which allows for accurate blood pressure monitoring as well as blood sampling [5]. The use of recombinant factor VIIa has been reported in the literature, though data on its use is limited and conflicting. Research suggests that the use of recombinant factor VIIa most likely should be reserved for cases where conventional resuscitative measures fail [1]. Increasing evidence suggests the use of thrombelastometry for early identification of patients with AFE but also to guide management, providing a point of care for monitoring during the hemorrhagic phase of AFE [17].

**137**

and fetal outcomes.

*Amniotic Fluid Embolism*

*DOI: http://dx.doi.org/10.5772/intechopen.85726*

of the treatment approaches mentioned.

despite more conservative measures.

myocardial infarction [5, 9].

**8. Summary**

**7. Outcomes**

Additional approaches to treatment of amniotic fluid embolism reported in the literature include extracorporeal membrane oxygenation (ECMO), plasma exchange transfusions, cardiopulmonary bypass, uterine artery embolization, continuous hemofiltration, pulmonary artery thromboembolectomy, intra-aortic balloon pump with ECMO, high-dose corticosteroids, C1 esterase inhibitors, and serum protease inhibitor therapy. There are no high-quality data available for many

Aprotinin is a single-chain polypeptide derived from bovine tissues and is an inhibitor of proteolytic enzymes [9]. It is used in the treatment of hemorrhage associated with raised plasma concentrations of plasmin and may be effective for hemorrhage associated with AFE. Other fibrinolytic agents like tranexamic acid and aminocaproic acid are used in the management of hemorrhage and may be useful. Hysterectomy is necessary in individuals when uterine hemorrhage persists

Mortality associated with amniotic fluid embolism appears to have declined which is likely associated with early diagnosis as well as improvements in critical care [4, 5, 9]. Disease severity (i.e., the presence or absence of cardiac arrest) is closely related to prognosis. Mortality rates vary greatly depending upon criteria used for diagnosis of AFE but have been reported as high as 60–70% [1, 9, 14]. The use of population-based studies appears to provide the best available evidence of the mortality rate associated with AFE. Analysis of a collection of 9 populationbased studies published since 1999 which included more than 17 million births in 8 countries and 751 cases of amniotic fluid embolism revealed an overall mortality rate of 20.3% [7]. Morbidity, however, remains extremely high and can include serious neurologic impairment, renal failure, cardiac failure, arrhythmias, and

Although limited data is available, neonatal survival rates are reported in the range of 70% [4, 5, 9]. Survival is dependent upon timing of delivery relative to onset of symptoms. Neonates delivered prior to onset of symptoms or soon after

There is no data to suggest that survivors of AFE have an increased risk of recurrence in a subsequent pregnancy. However, the risk of recurrence is unknown. There have been published case reports of successful pregnancies following an AFE.

Amniotic fluid embolism remains an elusive disease with catastrophic outcomes.

The pathophysiology remains unclear even with new research developments over the last 10 years. However, the theory that the syndrome may be caused by an abnormal maternal proinflammatory response incited by fetal components is promising. The variation in maternal response to fetal and amniotic components present in the maternal circulation may provide useful information and requires further investigation. Various laboratory tests and biomarkers have been proposed that may aid in diagnosis of an AFE; however, there is no gold standard diagnostic test available at this time. AFE remains a diagnosis of exclusion and relies on clinical judgment. A high level of suspicion in laboring or postpartum women with acute cardiopulmonary compromise or coagulopathy is required for optimal maternal

onset of symptoms have lower rates of morbidity and mortality.

#### *Amniotic Fluid Embolism DOI: http://dx.doi.org/10.5772/intechopen.85726*

Additional approaches to treatment of amniotic fluid embolism reported in the literature include extracorporeal membrane oxygenation (ECMO), plasma exchange transfusions, cardiopulmonary bypass, uterine artery embolization, continuous hemofiltration, pulmonary artery thromboembolectomy, intra-aortic balloon pump with ECMO, high-dose corticosteroids, C1 esterase inhibitors, and serum protease inhibitor therapy. There are no high-quality data available for many of the treatment approaches mentioned.

Aprotinin is a single-chain polypeptide derived from bovine tissues and is an inhibitor of proteolytic enzymes [9]. It is used in the treatment of hemorrhage associated with raised plasma concentrations of plasmin and may be effective for hemorrhage associated with AFE. Other fibrinolytic agents like tranexamic acid and aminocaproic acid are used in the management of hemorrhage and may be useful. Hysterectomy is necessary in individuals when uterine hemorrhage persists despite more conservative measures.
