This is because we now have an improved understanding of the pathophysiology of the condition, based on recent research. 5 Based on this presumed pathophysiologic mechanism, this syndrome was originally designated amniotic fluid embolism but it is now known as anaphylactoid syndrome of pregnancy (ASP). ![]() This was based on autopsy reports of eight women who died during labor in whom such squamous cells were identified. 4 Originally, it was hypothesized that fetal squamous cells entering the maternal circulation and obstructing the pulmonary vascular tree were responsible for the hemodynamic manifestations of this condition. Most cases of ASP occur peripartum, during labor (70%) or within minutes of delivery (30%). Disseminated intravascular coagulation (DIC) can result in massive hemorrhage and may be detected clinically by bleeding from the vagina, during cesarean, or from the incision postoperatively, intravenous sites or the bladder (hematuria.) In the acute care setting, presence of coagulopathy may be the only clinical feature distinguishing ASP from massive pulmonary embolism however, the latter occurs primarily in the postpartum period whereas ASP is primarily an intrapartum condition. Both of these processes result in signs of fetal hypoxia and FHR abnormalities, which often precede maternal cardiopulmonary manifestations.Ĭoagulopathy is also a major component of classic ASP, although some patients may expire before their clotting status can be assessed. Fetal heart rate (FHR) tracing and uterine contraction monitoring may reveal uterine tachysystole as a direct result of maternal catecholamine release this initial shock reaction also includes shunting of uterine blood from the uterus and placenta to transiently maintain blood pressure and perfusion of maternal vital organs. 2,3 Seizures may also occur with this condition, which may be mistaken for eclampsia. Patients may experience symptoms of anxiety, a sense of impending doom, confusion, or shortness of breath which are accompanied by abnormal vital signs (Table 1), loss of consciousness, or cardiopulmonary arrest. ASP usually occurs during labor or within minutes of delivery, either vaginal or cesarean. 2 In less typical cases, one or more of these signs may be blunted or absent. ![]() Women with ASP may present with the classic triad of hypoxia, hypotension, and coagulopathy resulting in sudden cardiovascular collapse or cardiac arrest.
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