Diagnosis
> Presumptive - based on clinical presentation after considering other causes of haemodynamic instability
> Premonitory symptoms, such as restlessness, numbness, agitation, tingling, may have been present
> Currently, there is no definitive diagnostic test.
> The United Kingdom Obstetric Surveillance system (UKOSS) and the United States registry recommend the following criteria, all of which must have occurred in the context of labour, caesarean delivery, dilation and evacuation, or within 30 minutes postpartum with no other explanation of findings, to make the diagnosis of AFE
> Acute hypotension or cardiac arrest
> Acute hypoxia
> Coagulopathy or severe haemorrhage
OR
> Women in whom the diagnosis was made at post-mortem examination with the finding of fetal squames or hair in the lungs
Differential diagnosis
> Anaphylaxis
> Aortic dissection
> Cholesterol embolism
> Myocardial infarction
> Pulmonary embolism
> Septic shock
|
Clinical features of AFE compared to pulmonary embolism |
|
|
AFE |
PE |
|
Timing of onset |
Most likely to occur during delivery |
Any time |
|
Early symptoms |
Dyspnoea, restlessness, panic, feeling cold, parasthesiae, pain less likely |
Dyspnoea, cough, haemoptysis |
|
Collapse |
Highly likely |
May occur |
|
DIC |
Highly likely |
Absent |
|
ECG |
Non specific |
Non specific |
|
CXR |
Pulmonary oedema, ARDS, right atrial enlargement, prominent pulmonary arc |
Segmental collapse, raised hemidiaphragm, unilateral pleural effusion |
|
ABG |
Non specific |
Non specific |
|
CTPA |
Negative |
Positive |
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