Maximum chances of amniotic fluid embolism is seen at-
Ans is 'c' i.e., Labor o Almost 80% of the cases of amniotic fluid embolism develop during labor.Amniotic Fluid Embolismo Liquor amnii is forced into the maternal circulation either through a rent in the membranes or placenta. Thromboplastin rich liquor amnii containing the debris, blocks the pulmonary arteries and triggers the complex coagulation mechanism leading to DIC.o There is massive fibrin deposition distributed throughout the entire pulmonary vascular tree. If the patient survives from the severe cardiopulmonary embarrassment which stimulates thromboembolic phenomenon, there will be severe clotting defect with profuse bleeding per vaginam or through the venopuncture sites due to consumption of coagulation factors.o From the damaged endothelium of the pulmonary arteries, massive fibrinolytic activators are produced which excite the fibrinolytic system converting the plasminogen to plasmin which in turn produces lysis of fibrin, fibrinogen and even the factor V and factor VIII.o Thus, there is secondary fibrinolysis on top of primary fibrinogen depletion arising out of DIC.Amniotic Fluid Embolish : Risko Older ageo Multiparityo Physiologic Intense uterine contractionso Drug-induced intense uterine contractionso Caesarian sectiono Uterine ruptureo High cervical tearo Premature placental separationo Intrauterine fetal deatho Placental abruptiono Trauma to abdomen# 80% of cases develop during labor# 20% may develop before or after labor
First trimester
Second trimester
Labor
Post partum
Thromboembolic Disorders