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Regarding amniotic fluid embolism (AFE) is it true that the following changes may occur?

True / False

Thrombocytopenia Correct

Prolonged prothrombin time (PT) and partial thromboplastin (PTT) Correct

Increased cardiac output Correct

Hypercapnia and hypoxaemia Correct

Pulmonary vasoconstriction Correct

Explanation

Amniotic fluid embolism (AFE) syndrome is a biphasic process (sudden embolisation of amniotic fluid or fetal debris into maternal circulation) triggering profound alterations in haemodynamics and oxygenation. AFE results in pulmonary vasoconstriction and hypertension due to the release of arachidonic acid, prostaglandins and leukotrienes.

It is characterised by four cardinal signs:

Respiratory distress

Cyanosis

Cardiovascular collapse, and

Coma.

AFE is associated with decreased cardiac output, and hypotension. It can also result in disseminated intravascular coagulopathy, which is associated with prolonged PT and PTT, and thrombocytopenia.

Finally, arterial blood gas typically shows hypercapnia, hypoxia and a mixed respiratory and metabolic acidosis.

Reference:

Bready L, Mullins R, Noorily S, Smith R. Decision Marking in Anaesthesiology: An Algorithmic Approach. 3rd Edition. Maryland Heights, MO: Mosby Elsevier; 2007. pp 436-37.

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