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.