When we speak of an embolism, the image of a blood clot circulating in the arteries or veins always comes to mind. But in the case of embolism during pregnancy, the object that generates the problem is the amniotic fluid.
It is a disease with very little prevalence among pregnant women, but it cannot be ruled out. Although less than one woman for every 60,000 presents it, its appearance forces us to take quick and accurate measures to save both lives.
What is embolism during pregnancy?
The condition of embolism in pregnancy, also known as “amniotic fluid embolism” or “anaphylactic syndrome of pregnancy,” is the appearance of amniotic fluid within the mother’s blood. It is not always the fluid itself introduced into the stream but is sometimes generated by cells of the fetus.
The condition that must occur is the point of contact between the maternal blood and the amniotic fluid. This can happen in a normal vaginal delivery or a cesarean section as well. It is less common to arise from an amniocentesis, but it is among the complications derived from the procedure.
In amniocentesis, a doctor inserts a needle-like device into the pregnant woman’s belly to take a biopsy of the amniotic fluid. This happens in vivo, that is to say, that the gestation follows its normal course. If sufficient precautions are not taken, part of the fluids may come into contact.
In reality, the pathophysiology of the disorder is not known so far. This means that science has not deciphered why the mother reacts so seriously to the amniotic fluid that is it’s own. Nor does it happen in all women, which further complicates the picture.
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Symptoms of embolism during pregnancy
Amniotic fluid embolism leads to fatal outcomes if not treated promptly. The last stage of the pathology is cardiorespiratory arrest caused by an allergic reaction of the mother. It is as if it were anaphylaxis of excessive proportions.
Before reaching that point, the starting signs are as follows:
- Nausea and vomiting of the mother
- Seizures: This can confuse doctors with pre-eclampsia or eclampsia. The fact that blood pressure values do not tend to rise is usually differential.
- Fetal distress: This is the situation where the fetus shows signs of being under life stress. The heartbeat and breathing can be accelerated or slowed down, with the relaxation of the sphincters inside the belly. Expected movements also change, and the child tends to be quieter than usual for gestational age.
The severity is such that it is calculated that almost half of those affected die—those who do not have the possibility of complicating bleeding associated with childbirth and the placenta. In the long term, blood loss leads to anemia.
The initial treatment for embolism during pregnancy, when detected, consists of providing support to the woman who suffers from anaphylaxis. This is accomplished with measures that are common to other giant allergic reactions.
Oxygen supply is key to feeding the respiratory dynamics that usually increases at the beginning to enter a stage of depression later. This requires hospitalization in intensive care, given the possibility of using an artificial respirator.
Second, fluid control is critical. Intravenous lines are placed to inject the fluid that supports the heart’s pumping. Still, cardiovascular parameters are also monitored, and medications are given to stimulate the heart muscle to avoid entering the state of shock.
The use of drugs in these pregnant women is guided more by the risk/benefit ratio than by their possible teratogenic effects. In general, the embolism of pregnancy appears at the end of it, and children are already fully formed in their organs.
What happens to the child at birth in these conditions?
The situation of babies at the birth of mothers with amniotic fluid embolism is complicated. If they have gone through fetal distress stages, neonatologists are in a hurry to regain vital signs.
Resuscitation may be required at the delivery or cesarean section, administration of body fluids, and oxygen support. Some babies are born in cardiorespiratory arrest and others with severe depression of their ventilatory mechanics.
Subsequent monitoring is needed for long days. Having gone through such a traumatic situation, specialized follow-ups are required to assess long-term complications. It is often unknown how long it was without oxygen supply inside the belly and in what state the nervous system has been.
How to prevent embolism of pregnancy?
It is almost improbable to prevent this pathology. There are no elements that reduce the risk or measures that can be taken that decrease the mother’s possibility of getting sick.
What is essential is specialized monitoring by obstetricians. Routine pregnancy controls are the only low-cost and safe way to contain possible complications of any kind that may arise.