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6 tips to help save lives in cases of AFE/ASP

August 30, 2019
Steven L. Clark, MD

Ob/gyns must be ready to move quickly when a patient exhibits the sudden and unexpected signs of anaphylactoid syndrome (ASP).

Anaphylactoid syndrome of pregnancy (ASP) remains a puzzling and deadly condition despite decades of recognition and research. As a result, ob/gyns must be ready to move quickly when a patient exhibits the sudden and unexpected signs of anaphylactoid syndrome (ASP).

If ASP is suspected based on the triad of hypoxia, hypotension, and coagulopathy in addition to timing around time of delivery, the first step is to provide high-quality cardiopulmonary resuscitation (CPR)

Left lateral uterine displacement, or in a potentially viable fetus (≥ 23 weeks gestation) delivery during resuscitation efforts may increase cardiac preload and improve the effectiveness of CPR by relieving inferior vena cava pressure caused by the gravid uterus.

Intubation will likely be needed for ongoing respiratory support.

Even prior to clinical signs of hemorrhage, it is recommended to notify the blood bank and perhaps activate a massive transfusion protocol is suspicion for APS is high since at least 80% of these women will develop disseminated intravascular coagulation.

ASP usually occurs during labor or within minutes of delivery, either vaginal or cesarean.

Based on the presumed pathophysiology of ASP, a novel regimen of atropine, ondansetron, and ketorolac has been proposed. 

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