AMNIOTIC FLUID AMBOLISM:
Amniotic fluid embolism is a rare but serious condition that occurs when amniotic fluid — the fluid that surrounds a baby in the uterus during pregnancy — or fetal material, such as fetal cells, enters the mother's bloodstream. Amniotic fluid embolism is most likely to occur during delivery or in the immediate postpartum period.
Amniotic fluid embolism is difficult to diagnose. If your doctor suspects you might have one, you'll need immediate treatment to prevent potentially life-threatening complications.
Amniotic fluid embolism might develop suddenly and rapidly. Signs and symptoms might include:
Amniotic fluid embolism occurs when amniotic fluid or fetal material enters the mother's bloodstream. A likely cause is a breakdown in the placental barrier, such as from trauma.
When this breakdown happens, the immune system responds by releasing products that cause an inflammatory reaction, which activates abnormal clotting in the mother's lungs and blood vessels. This can result in a serious blood-clotting disorder known as disseminated intravascular coagulation.
However, amniotic fluid embolisms are rare — and it's likely that some amniotic fluid commonly enters the mother's bloodstream during delivery without causing problems. It's not clear why in some mothers this leads to amniotic fluid embolism.
It's estimated that there are between one and 12 cases of amniotic fluid embolism for every 100,000 deliveries. Because amniotic fluid embolisms are rare, it's difficult to identify risk factors.
Research suggests that several factors might be linked to an increased risk of amniotic fluid embolism, however, including:
Amniotic fluid embolism can cause serious complications for you and your baby, including:
A diagnosis of amniotic fluid embolism is typically made after other conditions have been ruled out.
Your health care provider might order the following lab tests during your evaluation:
Amniotic fluid embolism requires rapid treatment to address low blood oxygen and low blood pressure.
Emergency treatments might include:
If you have amniotic fluid embolism before delivering your baby, your doctor will treat you with the goal of safely delivering your baby as soon as possible. An emergency C-section might be needed.
Coping and support
Experiencing a life-threatening pregnancy condition can be frightening and stressful for you and your family. Afterward, you might relive the experience and have nightmares and flashbacks.
During this challenging time, lean on loved ones for support. Consider joining a survivors' network. Also, work with your health care provider to determine how you can safely manage your recovery and your role as the mother of a newborn.
DILATION AND CURETTAGE (D&C)
Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.
In a dilation and curettage — sometimes spelled "dilatation" and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction.
Why it's done
Dilation and curettage can diagnose or treat a uterine condition.
To diagnose a condition
Your doctor might recommend a type of D&C called endometrial sampling to diagnose a condition if:
To perform the test, your doctor collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing. The test can check for:
To treat a condition
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When performing a therapeutic D&C, your doctor removes the contents from inside your uterus, not just a small tissue sample. Your doctor may do this to:
Your doctor may perform the D&C along with another procedure called a hysteroscopy. During a hysteroscopy, your doctor inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and up into your uterus.
Your doctor then views the lining of your uterus on a screen, noting any areas that look abnormal, making sure there aren't any polyps and taking tissue samples as needed. During a hysteroscopy, your doctor can also remove uterine polyps and fibroid tumors
Dilation and curettage is usually very safe, and complications are rare. However, there are risks. These include:
This can lead to abnormal, absent or painful menstrual cycles, future miscarriages and infertility.
Contact your doctor if you experience any of the following after a D&C:
How you prepare
Dilation and curettage may be performed in a hospital, clinic or your doctor's office, and it's usually done as an outpatient procedure.
Before the procedure:
In some cases, your doctor may start the process of dilating your cervix a few hours or even a day before the procedure. This helps your cervix open gradually and is usually done when your cervix needs to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain types of hysteroscopy.
To promote dilation, your doctor uses a medication called misoprostol (Cytotec) — given orally or vaginally — to soften the cervix or inserts a slender rod made of laminaria into your cervix. The laminaria gradually expands by absorbing the fluid in your cervix, causing your cervix to open.
What you can expect
During the procedure
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For dilation and curettage, you'll receive anesthesia. The choice of anesthesia depends on the reason for the D&C and your medical history.
General anesthesia makes you unconscious and unable to feel pain. Other forms of anesthesia provide light sedation or use injections to numb only a small area (local anesthesia) or a larger region (regional anesthesia) of your body.
During the procedure:
Because you're either unconscious or sedated during a D&C, you shouldn't feel any discomfort.
After the procedure
You may spend a few hours in a recovery room after the D&C so that your doctor can monitor you for heavy bleeding or other complications. This also gives you time to recover from the effects of anesthesia.
If you had general anesthesia, you may become nauseated or vomit, or you might have a sore throat if a tube was placed in your windpipe to help you breathe. With general anesthesia or light sedation, you may also feel drowsy for several hours.
Normal side effects of a D&C may last a few days and include:
For discomfort from cramping, your doctor may suggest taking ibuprofen (Advil, Motrin IB, others) or another medication.
You should be able to resume your normal activities within a day or two.
Wait to put anything in your vagina until your cervix returns to normal to prevent bacteria from entering your uterus, possibly causing an infection. Ask your doctor when you can use tampons and resume sexual activity.
Your uterus must build a new lining after a D&C, so your next period may not come on time. If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your doctor about when it's safe to start trying again.
Your doctor will discuss the results of the procedure after the D&C or at a follow-up appointment.