Incidence 1:8000 to 1:80000 births

Mortality 30-70%

Morbidity: Cerebral Hypoxia common

Pathology

Amniotic fluid, fetal cells, hair and other debris enter maternal venous circulation.

Release of biochemical mediators (Thromboxane, Leukotrienes, Prostaglandines) causing pulmonary artery vasospasm and right ventricular strain

Left ventricular failure (cause unclear) and DIC

Clinical presentation

Chills, fever, agitation

Hypoxaemia, respiratory distress, DIC, cardiac arrest

Differential diagnoses

Pulmonary embolism

Myocardial infarct

Air embolism

Anaphylaxis

Anaesthetic complication

Sepsis

Eclampsia

Pathophysiology

Hypoxaemia due to severe VQ mismatch

Bronchospasm

Cardiogenic shock (arrhythmias,VF, bradycardia)

DIC

Management

Early recognition

Mainly supportive

Delivery of foetus

ABC (Intubation, ventilation or NIV in less severe causes)

            Cave: difficult airway in pregnancy

Treatment of PAH with NO or prostaglandins

Correction of DIC