Amniotic fluid embolism is one of the most fatal birth complications, but thankfully it’s rare. Even so, women shouldn’t be kept in the dark about the risks of an AFE birth.
Below we’ll give you an overview of this dangerous condition, and share AFE survival rate information. We’ll also discuss why mishandling AFE is a recipe for a birth injury lawsuit.
What is Amniotic Fluid Embolism (AFE)?
It’s a rare, life-threatening medical emergency. Amniotic fluid embolism occurs during labor, that is, it typically occurs during labor. However, it can also happen during delivery, after delivery, or even during a late-stage abortion or following trauma to the abdomen during pregnancy.
It involves fetal cells, debris, or amniotic fluid entering the maternal bloodstream. A small invasion of fetal material into the mother’s bloodstream usually isn’t dangerous. But it triggers a major allergic reaction in some women. This reaction can lead to severe complications and even death.
AFE is very rare (it occurs in approximately 1 in 40,000 deliveries). But it’s still a leading cause of maternal death because of its high mortality rate. In fact, AFE causes between 7.5% and 10% of maternal deaths in the United States.
What Causes Amniotic Fluid Embolism?
Right now, doctors don’t know the exact cause of AFE. They believe it happens because of a breach in the placental barrier that separates maternal blood circulation from the amniotic fluid. This breach can occur because of trauma during labor. It can also happen right after birth.
AFE is more common in vaginal births. But it can happen during a C-section as well.
Symptoms of Amniotic Fluid Embolism
Let’s talk about the signs and symptoms of AFE. The body’s reaction to AFE is sudden and severe. Sometimes it happens too suddenly for doctors to diagnose and treat it.
To diagnose an amniotic fluid embolism the doctor might take an arterial blood gas (ABG) for example, and sometimes, they don’t do it quickly enough. Some women go into cardiac arrest before they show any other symptoms. But possible symptoms (and conditions) include the following.
Women with AFE may experience:
- Sudden shortness of breath
- Rapid breathing
- Rapid respiratory failure
- Low blood pressure
- Rapid heart rate
- Nausea
- Vomiting
- Confusion
- Seizures
- Losing consciousness
- Fetal distress
- Heart and lung failure
- Cardiac arrest (when the heart stops)
- Excessive bleeding (excessive and uncontrolled bleeding)
These are some of the most commonly reported conditions and symptoms of AFE. Generally, the symptoms associated with AFE include cardiovascular, respiratory, neurological, hemorrhagic, and skin symptoms, as well as fetal distress in the child.
When & How Does AFE occur?
Firstly, let’s discuss the how.
Here’s what happens when a woman experiences an amniotic fluid embolism:
- Trigger: A breach in the placental barrier triggers AFE. Amniotic fluid and debris enter the mother’s bloodstream.
- Allergic Reaction: The mother’s severe immune reaction to fetal material in the bloodstream causes a sudden drop in blood pressure. This leads to shock, seizures, and sometimes cardiac arrest.
- Cardiopulmonary Complications: Next, fluid may accumulate in the lungs. The woman can suffer complications like acute respiratory distress syndrome (ARDS) and cardiac arrhythmias.
- Severe bleeding: At this point, the body’s blood clotting mechanisms become dysfunctional. This is called coagulopathy. Blood clots in blood vessels and severe bleeding can happen simultaneously.
But what about the when?
When can AFE occur?
- During labor
- During an abnormal vaginal delivery
- During a C-section (Cesarean section)
- During an abortion
- In the second trimester of pregnancy
- Due to abdominal trauma
- During amnio-infusion (a procedure that injects fluid into the amniotic cavity during labor)
- After the delivery (up to 48 hours after)
Without quick medical intervention, a woman isn’t likely to survive an AFE birth. But even with swift intervention, mothers and babies may suffer complications from AFE.
Complications of Amniotic Fluid Embolism
The consequences of AFE can be catastrophic.
Short-term effects include:
- Hypotension (low blood pressure)
- Acute Pulmonary Hypertension
- Shock
- Irregular heart rhythms
- Pulmonary edema (fluid in the lungs)
- Acute respiratory distress syndrome (ARDS)
- Disseminated Intravascular Coagulation (DIC)
- Hemorrhage (severe bleeding)
- Complications from blood transfusions
- Organ dysfunction (especially heart, lungs, kidneys, and liver)
- Low oxygen levels in the brain, causing neurological dysfunction
The aftermath of an AFE birth can have lasting effects on a woman’s health.
Some potential long-term complications are:
- Permanent organ damage
- Permanent brain damage
- Lasting respiratory issues, such as decreased lung function and lung scarring
- Long-term heart issues, such as irregular heart rhythms
- Coagulation and blood disorders
- Post-traumatic stress disorder (PTSD)
- Infertility or problems with future pregnancies
- Chronic health conditions, such as hypertension, diabetes, or autoimmune disorders.
- Infant death (from oxygen deprivation, or other reasons related to not being delivered quickly enough)
- Maternal death
Not all women who survive AFE will experience the complications above.
The outcomes of AFE vary based on several factors:
- The severity of the initial event
- The effectiveness of medical intervention
- The woman’s overall health
- Other individual factors
AFE Survival Rate
Estimates for how many women survive AFE vary because doctors sometimes can’t pinpoint AFE as the exact cause of death. Some sources show the mortality rate for AFE could be as high as 80%. Other research places the rate between 20% to 60%.
Babies seem to fare better. The infant survival rate for AFE is around 70%.
Women who survive AFE should receive ongoing medical follow-up and care. It’s common for them to experience long-term complications. They may need to see specialists in various fields, such as cardiology, pulmonology, neurology, and psychological support.
Is there any way to prevent Amniotic Fluid Embolism?
Since the exact cause of AFE is not fully understood, there’s no way to prevent it. However, healthcare providers can take measures to minimize the risk of complications during childbirth.
Doctors should be aware of whether the mother has any conditions that increase her risk of AFE. They should monitor her condition at all times, and be prepared to respond quickly if any complications arise.
Risk Factors for Amniotic Fluid Embolism
Unfortunately, doctors can’t predict AFE.
But certain risk factors and conditions can increase the likelihood of it occurring:
- Advanced maternal age. Women over 35 face greater risks of complications like AFE during pregnancy and childbirth.
- Mothers who have had multiple pregnancies.
- Abnormal placental conditions, such as placental abruption and placenta accreta.
- Polyhydramnios (too much amniotic fluid).
- Trauma to the abdomen or uterus (such as a vehicle accident).
- Using certain medications (like oxytocin) to induce labor.
- Preeclampsia and eclampsia.
Keep in mind that a woman may have none of the conditions above, and still experience an AFE birth. Sometimes there’s nothing to blame but a “stroke of bad luck”. But on rare occasions, AFE can stem from a medical professional’s negligence.
How Do Doctors Treat AFE?
How is amniotic fluid embolism treated? Well, right now, there isn’t any “miracle treatment” for AFE. Doctors have to focus their efforts on treating the symptoms as they happen. They should try to stabilize the mother’s condition and deliver the baby as soon as possible, often by C-section.
Treatment and management options depend on the individual case but may include:
- Providing oxygen
- Inserting a pulmonary artery catheter to monitor the mother’s heart
- Blood transfusions
- Performing a hysterectomy (removing all or part of the uterus)
- Administering medications to support blood pressure and heart function
AFE Birth and Malpractice
Sometimes, AFE is like a cobra sneaking up from behind and attacking suddenly. It can happen without warning. This makes it difficult to diagnose and treat. So injuries and death from an AFE birth can be inevitable, even despite a doctor’s best efforts.
Other times, AFE is more like a lightning bolt, striking only after rumbling thunder has given fair warning. If doctors don’t heed that “fair warning”, they can be held responsible for subsequent injuries.
At times, failure to diagnose AFE can be grounds for a lawsuit. Mismanagement of AFE after diagnosis can also count as malpractice. However, the lawsuit would have to show that a doctor’s or hospital’s actions led to AFE complications or death.
Sorting through medical records to figure out exactly what happened is a major feat. Luckily, you don’t have to attempt it on your own. If you or a loved one face severe injuries from AFE due to negligence, call our expert lawyers. You may be entitled to compensation that can pay for medical expenses and more.
