Clinical meaning
Amniotic fluid containing fetal cells, vernix, and meconium enters maternal circulation through endocervical veins or placental site. This triggers massive complement activation and anaphylactoid response. Phase 1: Acute pulmonary vasospasm causing right heart failure and cardiogenic shock. Phase 2: Consumptive coagulopathy (DIC) from tissue factor release. Mortality approaches 60-80%.
Diagnosis & workup
Diagnostics & workup: - Diagnosis of exclusion: no definitive diagnostic test - Order ABG for hypoxemia and acid-base assessment - Order DIC panel (fibrinogen, D-dimer, PT/PTT, platelet count) - Order echocardiogram for acute right heart failure assessment - Order CXR for pulmonary edema pattern - Order BNP/troponin for cardiac involvement - Order CBC with peripheral smear - Order thromboelastography (TEG) for real-time coagulation status
Risk factors: - Rapid/tumultuous labor - Cesarean section - Advanced maternal age - Multiparity - Placental abruption - Eclampsia - Cervical lacerations - Amniotomy