All of the following are common clinical features of amniotic fluid embolism, EXCEPT?

DSSSB October 2024

Obstetrics & Gynaecology

Easy

Appeared in: DSSSB October 2024

Explanation

Amniotic Fluid Embolism (AFE) is a catastrophic obstetric emergency characterized by sudden cardiovascular collapse, which leads to profound hypotension (shock), not hypertension.
While uterine hypotonia (atony) and subsequent hemorrhage are common in AFE, especially due to the associated coagulopathy, the presence of 'maternal hypertension' in the option makes it the incorrect statement.
The pathophysiology involves an initial phase that leads to right and then left ventricular dysfunction, resulting in systemic hypotension and cardiogenic pulmonary edema.
Therefore, this option is the correct answer to the 'EXCEPT' question as it contains a feature that is the opposite of what occurs in AFE.

Option A: This is a hallmark sign of AFE. The entry of amniotic fluid into the maternal circulation triggers an intense inflammatory response in the lungs, leading to acute respiratory failure.
Option B: This is an expected and immediate consequence of AFE. The severe maternal hypoxia and cardiovascular collapse compromise blood flow to the placenta, leading to acute fetal distress, often seen as severe bradycardia or prolonged decelerations.
Option D: These are classic signs of the acute respiratory failure that characterizes the initial phase of AFE. Dyspnea (shortness of breath) and cyanosis (bluish skin) result from severe hypoxemia.

Clinical Relevance

Nursing practice connection: Knowing Clinical features of Amniotic Fluid Embolism (AFE) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must be able to rapidly recognize the signs of AFE, as it is a life-threatening emergency requiring immediate, coordinated team intervention. Key initial actions include calling for help (e.g., Code Blue), administering 100% oxygen, and establishing large-bore IV access for resuscitation.
AFE is a diagnosis of exclusion. The nurse's rapid assessment helps differentiate it from other emergencies like pulmonary embolism, eclampsia, or massive hemorrhage, guiding the medical team's response.
What if? If the patient presented with sudden severe hypertension, headache, and visual disturbances, the nurse should suspect severe pre-eclampsia or eclampsia, not AFE. The priority interventions would shift from managing shock to administering antihypertensives (like labetalol or hydralazine) and magnesium sulfate to prevent seizures.

How to Approach the Question

First, identify the core concept of the question, which is the clinical presentation of Amniotic Fluid Embolism (AFE).
Pay close attention to the keyword 'EXCEPT'. This signals that you must find the option that is NOT a feature of AFE.
Recall the classic triad of AFE: 1) sudden respiratory distress, 2) sudden cardiovascular collapse (profound hypotension/shock), and 3) coagulopathy (DIC).
Systematically evaluate each option against this triad.
Options A ('sudden onset of maternal respiratory distress') and D ('Severe dyspnoea and cyanosis') directly relate to the respiratory collapse component. These are features of AFE.
Option B ('Foetal distress') is a direct consequence of maternal hypoxia and circulatory collapse. This is also a feature of AFE.

Concept Tested & Keywords

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