Amniotic Fluid Embolism (AFE) (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 Okay, next complication.

    00:04 We're going to talk about another emergency, that's pretty serious.

    00:07 And this one is called an amniotic fluid embolus.

    00:10 And this occurs when amniotic fluid actually enters the bloodstream, and it causes an anaphylaxis reaction.

    00:18 So risk factors for an amniotic fluid embolus include abnormal placentation.

    00:23 And that's a fancy word for saying that our placenta is either not created in a way that's normal, or it's innervated into the uterine wall in an abnormal way, like an accreta.

    00:34 The other risk factor is going to be polyhydramnios.

    00:38 If we have a lot of fluid, there's absolutely an increased risk that that fluid could actually venture its way into the maternal bloodstream.

    00:46 The last risk factor is an operative delivery.

    00:49 So a client who's had a cesarean section, because we're opening up a lot of vessels in order to do the surgery, there may be a little bit of amniotic fluid that makes its way into the circulatory system.

    01:02 So thinking about other risk factor.

    01:04 Advanced maternal age. Now, it's not just being over 35.

    01:09 It's the other things that happen because your advanced maternal age, like gestational diabetes, which may lead to polyhydramnios, which is a risk factor.

    01:20 Or the fact that patients who were over the age of 35 are more likely to have a cesarean birth, an operative delivery.

    01:27 So it's not just the number, it's the other things that lead to an increased risk.

    01:32 If we have an induction of labor, that increases our risk.

    01:36 Not just because of the induction, but because we can have prolonged labor.

    01:41 We might be having an induction because of abnormal placenta or some other abnormality.

    01:46 We may be more likely to end in an operative delivery.

    01:50 So those things are going to increase the risk.

    01:53 Or having preeclampsia.

    01:56 We'll talk about preeclampsia in another lecture, but what I want you to think about is that with preeclampsia, one of the biggest factors is abnormal placentation.

    02:07 Remember? There you go.

    02:09 How will the nurse notice that someone has experienced an amniotic fluid embolism? Well, one of the things that's particularly scary about an amniotic fluid embolism is that it happens really quickly.

    02:20 So this may be a situation where the client says, "I'm just feeling really anxious and panicky.

    02:25 All of a sudden, I don't know why." That may be all you get.

    02:30 They may complain of chest pain. They may have shortness of air.

    02:34 One of the classic signs of an amniotic fluid embolism is the client is perfectly fine one moment, and they sit up and say, "I can't breathe." And that's the only warning sign you have.

    02:44 They may have an elevated temperature.

    02:46 So it may be a situation where the big temperature has been normal the entire day or postpartum, and then all of a sudden the temperature spikes to 102, 103 without any other explanation.

    02:58 And that may be your clue.

    03:00 Maybe hypotension as they begin to go into shock, or hypoxia, and you notice a decrease in the oxygen saturation.

    03:08 They may experience distended neck veins, and that, again, may be an indicator that oxygen flow is not ideal, and we have a blockage from the amniotic fluid embolism and from the anaphylaxis reaction.

    03:21 So what do we do? Well, at this point, we have to realize that this is a full OB emergency, we need to call a code, and bring the entire team in.

    03:30 Ventilator support is going to be very important to saving this client's life.

    About the Lecture

    The lecture Amniotic Fluid Embolism (AFE) (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Complications in Labor (Nursing).

    Included Quiz Questions

    1. An AFE is amnionic fluid that gets into the maternal blood.
    2. An AFE initiates an anaphylactic reaction.
    3. Abnormal placentation is a risk factor for AFE.
    4. Treatment for AFE is an immediate cesarean birth.
    5. An AFE is an air embolus that gets into the amnionic fluid.
    1. Hypoxia
    2. Shortness of breath
    3. Elevated temperature
    4. Hypertension
    5. Somnolence

    Author of lecture Amniotic Fluid Embolism (AFE) (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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