Obstetrics and Gynecology - A.M. Gromova 2000
Obstetric Hemorrhage
Hemorrhage in the Placental and Early Postpartum Periods
Amniotic Fluid Embolism (AFE)
The entry of Amniotic Fluid (AF) into the maternal bloodstream leads to the sudden death of a pregnant woman, woman in labor, or puerpera.
Amniotic fluid embolism (AFE) occurs when the amniotic pressure exceeds the venous pressure and there are gaping venous vessels in the Uterus, cervix, or placental site. It is known that AF contains epithelial debris, Proteins, metabolic products, histamine, serotonin, Prostaglandins, and potential meconium impurities.
In cases of macrosomia, polyhydramnios, Multiple Pregnancy, excessive or uncoordinated labor, or a rigid cervix, amniotic pressure rises and exceeds venous pressure. If premature placental abruption, Premature Rupture of membranes, manual examination of the uterine walls, Cesarean Section, or deep Cervical lacerations occur under these conditions, AF may enter the maternal bloodstream. The sudden entry of AF into the pulmonary vessels triggers arteriolobronchospasm, followed by The Development of cardiopulmonary Shock, acute right ventricular failure, and a sharp drop in Blood pressure. In The first phase, As a result of vasospasm, bronchospasm, and an anaphylactic reaction, shock and Hypoxia develop, followed by disseminated intravascular coagulation (DIC) syndrome (phase II).
The Clinical symptoms of acute AFE include cough, cyanosis, dyspnea, chest pain, chills, and tachycardia. A comatose state develops rapidly, accompanied by cardiac fibrillation and sudden death. When a small amount of AF enters the Circulation, it causes chills, agitation, Skin pallor, and convulsions, with the potential development of DIC syndrome, acute cardiovascular failure, and pulmonary edema. With timely and intensive therapy, the patient can recover from shock.
The Diagnosis is established based on the clinical manifestations, hemostatic profile, ECG findings (deep Q wave in lead I, elevated T wave in lead III), and measurements of central venous pressure (CVP), blood pressure, and urinary output.
Differential diagnosis is performed to rule out myocardial infarction, Other forms of shock, and Different types of embolism.
Treatment includes: assisted ventilation with oxygen, intubation, and mechanical ventilation. If necessary, closed-chest cardiac massage is performed. Sedatives (diazepam, GHB, relanium, seduxen) and antihistamines (diphenhydramine, suprastin), vasodilating bronchodilators, and antispasmodics (aminophylline, papaverine, promedol, platifyllin, no-shpa, glucose-novocaine mixture, spasmalgin, baralgin) are administered. Corticosteroids (hydrocortisone up to 1000 mg per day, or prednisolone, dexasone), cardiac Glycosides (corglycon, strophanthin), cocarboxylase, and calcium chloride are prescribed. Fresh frozen plasma, native plasma, rheopolyglucukin, albumin, cryoprecipitate, dicynone, contrical, or trasylol are used to prevent and treat DIC syndrome and correct hypovolemia.
Infusion therapy is monitored using urine output control. Metabolic acidosis is corrected by administering a 4-5% sodium bicarbonate solution or trisamine.
Therapy aimed at stopping uterine bleeding is implemented: uterotonics (oxytocin, methylergometrine, prostaglandins) are administered. If medical therapy is ineffective, Surgical Methods to stop the bleeding are performed (laparotomy, Hysterectomy without adnexa combined with ligation of the internal iliac Arteries).
Once the shock is resolved, subsequent therapy focuses on preventing renal failure, acute respiratory distress syndrome, and septic complications; heparin therapy is administered under the control of the hemostatic system.
In the event of cardiac arrest: intubation, mechanical ventilation, closed-chest cardiac massage, and intracardiac administration (in the 5th left intercostal space) of 5 ml of a 10% calcium chloride solution with 1 ml of a 0.1% adrenaline solution. Defibrillation is performed.
To prevent AFE, proper preparation for childbirth, atraumatic delivery, and the correct Management of Labor and the postpartum period are essential.
1. What is the Etiology, Pathogenesis, Classification, and incidence of Placenta Previa?
2. Describe the Clinical Presentation and diagnosis of placenta previa.
3. How is treatment managed in patients with placenta previa?
4. Define the concept, etiology, pathogenesis, and incidence of placental abruption (premature Separation of a normally implanted placenta).
5. What is the clinical picture and treatment of placental abruption?
6. What causes bleeding in the Third Stage of labor and the early postpartum period?
7. What is the classification, causes, clinical presentation, and treatment of abnormal placentation: placenta accreta and placenta increta/percreta?
8. What are the causes, Clinical Features, diagnosis, and treatment of disorders in placental separation and expulsion, such as retained placental fragments or trapped placenta?
9. Uterine Hemorrhage due to uterine hypotonia and atony: clinical presentation, diagnosis, and treatment.
10. What measures are used to combat acute anemia?
11. Bleeding caused by Blood Coagulation disorders: causes, clinical presentation, and management.
12. What is hemorrhagic shock, and what are its stages?
13. How does amniotic fluid embolism develop? Clinical presentation and management.
Last update: 08/08/2026
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