How to differentiate Amniotic fluid embolism and Pulmonary embolism?

	Amniotic Fluid Embolism	Pulmonary Embolism
Onset of symptoms	Usually during labour	Any time in pregnancy
Early symptoms	Dyspnoea, restlessness, panic, feeling, cold, paraesthesiae. Usually no pain	Breathlessness, , cough, haemoptysis, pleuritic pain
Coagulopathy	Present	Absent
ECG	Not helpful	S1Q3T3
Chest x-ray:	Pulmonary oedema, ARDS, right atrial enlargement, prominent pulmonary artery.	Segmental collapse, raised hemidiaphragm, unilateral effusion
CTPA	Negative	Positive
Complement levels	Raised	Normal
Serum Fetal Sialyl Tn antigen	Present	Absent

Nine maternal risks of Obesity and Three fetal risks of maternal obesity

 

Mother

1.   Severe morbidity – surgical or aneshtetic

2.   Cardiac disease

3.   Spontaneous miscarriage

4.   Pre-eclampsia

5.   Gestational diabetes

6.   Thromboembolism

7.   Post caesarean wound infection

8.   Infection from other causes

9.   Post partum haemorrhage

Baby

1.   Stillbirth and neonatal death

2.   Congenital abnormalities (can be missed by scan)

3.   Prematurity

Reasons why tachycardia is important in a pregnant patient?

 Presence of tachycardia is the most significant clinical feature of an unwell patient and is regularly ignored or missed   or misinterpreted .

Measurements of respiratory rate and heart rate are seriously more important than measurements of blood pressure.

A normotensive patient may all too often be unwell and compensating.

 A tachycardic patient is hypovolemic until proved otherwise.

A patient with tachypnea has a cardiorespiratory cause until proved otherwise.

Do not attribute presence of tachycardia and tachypnea to anxiety

Three most important causes of abdominal pain in later stages of pregnancy

1. PET, eclampsia and HELLP syndrome, especially if the pain is epigastric or accompanied by jaundice 
2. Placental abruption   
3. Sepsis

Ten Red Flag Signs of Maternal sepsis

1.   Pyrexia > 38_C

2.   Sustained tachycardia > 100 bpm

3.   Breathlessness (RR > 20)

4.   Abdominal or chest pain

5.   Diarrhoea and/or vomiting

6.   Reduced or absent fetal movements, or absent fetal heart

7.   Spontaneous rupture of membranes or significant vaginal discharge

8.   Uterine/renal angle pain and tenderness

9.   appears or feels generally unwell 

10.        Unduly anxious, distressed 

The combination of any of the above two makes a seriously valid case for correct thought process to rule out maternal sepsis. Of all the vital signs respiratory rate is the most important variable for assessing the clinical situation of the patient. Respiratory rate is the most sensitive indicator of patient's physiological well being.