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Amniotic Fluid EmbolismAka: Pulmonary Embolism of Amniotic Fluid

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  1. See Also
    1. Pulmonary Embolism in Pregnancy
    2. Pulmonary Embolism
  2. Signs
    1. Severe shock of rapid onset
    2. Severe Dyspnea
  3. Risk factors
    1. Amniotomy
    2. Strong uterine contractions
  4. Differential diagnosis
    1. Pregnancy Induced Hypertension
    2. Abruptio Placentae
    3. Uterine Rupture
    4. Aspiration Pneumonia
  5. Lab
    1. Arterial Blood Gas
    2. Complete Blood Count with platelets
    3. Urinalysis
    4. Type and Cross 4-6 units packed Red Blood Cells
    5. Coagulation studies
      1. ProTime (PT)
      2. Partial Thromboplastin Time (PTT)
      3. Fibrin split products (Fibrin Degradation Products)
      4. Fibrinogen
      5. Clot Test
  6. Monitoring
    1. Check Hemoglobin every 1 hour (keep above 10 mg/dl)
    2. Check Hematocrit every 1 hour (keep above 30)
    3. Check coagulation studies every 2 hours
    4. Fetal scalp electrode
    5. Tocometry or intrauterine pressure catheter
    6. Monitor strict intake and output
      1. Keep urine output > 30 cc per hour
  7. Management
    1. Admit to intensive care unit
    2. Oxygen Supplementation
    3. Intravenous Access
    4. Consultations
      1. Obstetrics
      2. Medicine
      3. Neonatology

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