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SMFM Guideline on Amniotic Fluid Embolism Management

Am J Obstet Gynecol; ePub 2016 Mar 14; Pacheco, Saade, et al

The Society for Maternal-Fetal Medicine (SMFM) has issued clinical guidelines for the diagnosis and management of amniotic fluid embolism (AFE). Among the recommendations:

• SMFM recommends consideration of AFE in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman (grade 1C).

• SMFM does not recommend the use of any specific diagnostic laboratory test to either confirm or refute the diagnosis of AFE; at the present time, AFE remains a clinical diagnosis (grade 1C).

• SMFM recommends the provision of immediate high quality cardiopulmonary resuscitation with standard BCLS and ACLS protocols in patients who develop cardiac arrest associated with AFE (grade 1C).

• SMFM recommends that the involvement of a multidisciplinary team including anesthesia, respiratory therapy, critical care, and maternal-fetal medicine should be involved in ongoing care of such women (best practice).

• Following cardiac arrest with AFE, SMFM recommends immediate delivery in the presence of a fetus ≥23 weeks of gestation (grade 2C).

• SMFM recommends the provision of adequate oxygenation and ventilation and, when indicated by hemodynamic status, the use of vasopressors and inotropic agents in the initial management of AFE. Excessive fluid administration should be avoided (grade 1C).

• Since coagulopathy may follow cardiovascular collapse with AFE, SMFM recommends early assessment of clotting status and early aggressive management of clinical bleeding with standard massive transfusion protocols (grade 1C).

Citation: Society for Maternal-Fetal Medicine (SMFM), Pacheco LD, Saade G, Hankins GVD, Clark SL. SMFM clinical guidelines No. 9: amniotic fluid embolism: diagnosis and management. [Published online ahead of print March 14, 2016]. Am J Obstet Gynecol. doi:http://dx.doi.org/10.1016/j.ajog.2016.03.012.

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