Amniotic Fluid Embolism Scare...

Specialties Ob/Gyn

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I am relatively new to this board but have loved all the interesting input from everyone. I could really use some input now...

Brief history: 19yo G1P0, term, no polyhydramnios, srom'd clear fluid, labor proceeded just fine got epidural at 6cm , pushed

I run into the OB a few days ago and she tells me--"guess what pathology found?" Multiple amniotic fluid emboli in the vasculature of the uterus. :eek: Holy crap! I still get goose bumps! It's what sent her into DIC but her circulating volume was so low-- the DIC also kept her alive.

She went home 96 hours after delivery and she is doing great now. WOOHOO!

I have no doubt that she was meant to live and be there for her daughter. It was not her time.

I've been a L&D nurse for 6 years and have been the nurse in several OB emergencies--MTP's and all, but after finding out about the AFE--I'm just a little wigged out. We had a maternal death a couple of years ago from one.

Have any of you had an experience like that? Any feedback is much appreciated.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

wow what a mighty scare. Yes I have had patients hemorrhaging, going into shock, telling me they are dying (and they are)-----and have them turn around by the grace of God.........and the interventions the doctors and we do. It's horrendous----it's a sick feeling cause you feel helpless and you want to reassure them, but are just quaking inside. Bless your heart. What a scare...what a horrible event. She is lucky to have survived, let alone recovered. That is an incredibly deadly thing, embolism. Way to go on a job well-done, you deserve kudos!

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Hi, I have been in OB for 4 months and find this thread exciting but somewhat confusing......What is a MTP? How did the embolisms develop, where were they located etc. Obviously they were in her uterus but how did they develop, where they there the whole pregnancy and once placenta released then bleed out??????Help need to know more specifics for my future reference. Hope to never see something of this nature. We seem to get a few retained placentas and pph but nothing like this. Glad the new mom is ok.

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I had a pt who was brought in by ambulance - they were doing cpr on her. She was in her late 20's and 8mo pregnant. Family found her passed out in her home. As we took over cpr, ob came down and did a c-section while we were trying to bring her back - It was amazing. Her baby was in distress. He was sent to NICU. Mom didnt make it. It wasnt until the autopsy that we found out she had an amniotic emboli. Considering the majority of our pts are positive for cocaine and benzos - we had assumed that she had probably been doing drugs. Her drug screen came back negative. Her family was TORE UP! Her mother is raising the baby. She comes into the er from time to time with asthma. She brought us a picture of the baby. He's about 2yrs old and very healthy. Ill never forget that day. As she was dying, her baby was fighting to live.

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Hi, I have been in OB for 4 months and find this thread exciting but somewhat confusing......What is a MTP? How did the embolisms develop, where were they located etc. Obviously they were in her uterus but how did they develop, where they there the whole pregnancy and once placenta released then bleed out??????Help need to know more specifics for my future reference. Hope to never see something of this nature. We seem to get a few retained placentas and pph but nothing like this. Glad the new mom is ok.

Questiosn are good.Massive Transfusion Protocol. It's what is initiated by blood bank when a patient meets specifc criteria for a massive transfusion of blood and products. This pt had an INR of 2.03. Our facility initiates at 1.5. Her FDP was >40m.The emboli were located in the vasculature of the uterus.

If you want to know more about AFE--just google it. There are many great articles about on the web.

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This was a very interesting post.

I came across this doing a search on it:

http://personal.uncc.edu/cmaynard/amniotic.htm

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Wow, just reading this post really makes me want to become a L&D Nurse. Not just because I find it so interesting, but because I want to understand what you all are saying!!!!!!!

I understood about 5 words in that whole post!!! (not really, but pretty close!!)

In any case, I'm so glad the woman survived to raise her daughter. I assume this is a pretty rare and very deadly thing.

How do you handle situations like that? Where the chances of the patient dying are so great? Do you tell them they are going to be fine?

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Wow, just reading this post really makes me want to become a L&D Nurse. Not just because I find it so interesting, but because I want to understand what you all are saying!!!!!!!

I understood about 5 words in that whole post!!! (not really, but pretty close!!)

In any case, I'm so glad the woman survived to raise her daughter. I assume this is a pretty rare and very deadly thing.

How do you handle situations like that? Where the chances of the patient dying are so great? Do you tell them they are going to be fine?

I am sorry; we do get quite technical here. If you have questions, just ask and I am happy to help you anyway I can.

How do I handle situations like this?

First, I never lie to my patients, telling them all will be ok, when I am unsure that is true. I do say: "We are doing everything possible we can for you and your baby. You are in good hands and we are trained and experienced in dealing with emergencies. I promise to keep you abreast of what is happening as it develops and as we know so you are not kept in the dark".

I can say the above with absolute veracity and build trust that way. And I try never to leave the patient's side when she is in crisis. That is a very important thing to do. Hope this helps.

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I had a patient the other day who had an inverted uterus after a routine SVD. We got her to the OR; she lost her total body volume of blood, about 5000cc. Her BP was 49/19 at one point. At that moment, she looked at me and said, "There are angels all around. I can't see them but I know they're here." When she came back a little, she said "I went to heaven." I said, "Are you back, because you need to stay here and raise your kids." and she said "yeah, I'm back. But it didn't hurt when I was there and it hurts here." She got much, much blood and blood products, but is going home tomorrow. Thank God. It was a goosebumpy experience for me and all the OR team. She did lose her uterus, but she's okay now. Our anesthesiologists were great in this crisis, and I was so glad to be a nurse that day, and part of the team. Some days you feel you really do make a difference!

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Wow! what interesting stories.

I have had one pt lose her uterus, due to uterine atony despite meds and massage. We also lost a pt to AFE last February. She coded, then went into DIC and started bleeding out while we tried to resuscitate her. From SROM to maternal death was a little over an hour. I'm amazed we were able to get the baby out. The horrible thing was, we were sending her home for early labor when she stood up and her water broke. If it had happened at home, they both would have died.

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How do you handle situations like that? Where the chances of the patient dying are so great? Do you tell them they are going to be fine?

When she looked at me and said "I don't want to die, please don't let me die" I said "I don't want you to die either. We are all going to do everything we can to make sure you see that baby of yours--your daughter who is back in that room with Dad. They're waiting for you to come back to them."

I always learned from my Professors in nursing school that you develop a sixth sense--intuition--what have you. It's true. I knew this girl was going to lose her uterus when I gave the hemabate. I have had several post partum hemmorhages that lead to emergency hysts and massives transfusions. I just knew that this was too much of a blood loss.

As far as handling a situation like that--you do your job. Professional and caring. We have drills on MTP and OB emergencies. I also am the "lucky" one since I have been the nurse on a few, they(managers) figure I know what I am doing and often take over on the patient and go to the OR. Also-you just dig in for the ride and chart your *** off.

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Having lunch with my friend who happened to be the other nurse in the OR with me that day and we ran into a family member of the patient I told you all about...they told us that the patient is doing great--a little weak, but doing great. Baby is doing well too. They thanked us for the care that we gave. It was so nice to know how she was doing and that her family was so appreciative of what we did (and we were just doing our job). That's what it's all about. The difference we all make in someone's life everyday. That's my reward. You can't measure it in money. It fills up my soul and makes it easier to take of those that don't get how precious life is.

To all of you who go out there everyday and give the best care you can and do it day after day--YOU ROCK! THANK YOU! To those of you who are still in school to become nurses--DO IT! It is the most rewarding profession you can enter.

---off my soap box and exit stage left

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