Establishing evidence-based recommendations for intervention is an important goal for the near future. Amniotic fluid embolism (AFE) is one of the most catastrophic complications of pregnancy in which it is postulated that amniotic fluid, fetal cells, hair, or other debris enters the maternal pulmonary circulation, causing cardiovascular collapse. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. The response can be life threatening to both mother and to her baby (ies) if she develops this before delivery. The histological or immunohistochemical demonstration of formed amniotic fluid components in the pulmonary bloodflow establishes the diagnosis of AFE.ĪFE has become more common in recent years, for unclear reasons. Amniotic fluid embolism (AFE) is a rare and unexpected birth complication that may occur when a mother suffers an allergic-like response to amniotic fluid that may enter her bloodstream during labor or shortly after delivery. The sudden, unexplained death of a pregnant woman necessitates a forensic autopsy. Low-level evidence favors treating women suffering from AFE by securing the airway, adequate oxygenation, circulatory support, and correction of hemostatic disturbances. Its treatment requires immediate, optimal interdisciplinary cooperation. Its main clinical features are severe hypotension, arrhythmia, cardiac arrest, pulmonary and neurological manifestations, and profuse bleeding because of disseminated intravascular coagulation and/or hyperfibrinolysis. AFE is diagnosed on clinical grounds after the exclusion of other causes of acute cardiovascular decompensation during delivery, such as pulmonary thromboembolism or myocardial infarction. The identified risk factors for AFE are maternal age 35 and above (odds ratio 1.86), Cesarean section (OR 12.4), placenta previa (OR 10.5), and multiple pregnancy (OR 8.5).
We selectively reviewed pertinent literature published from 2000 to May 2013 that was retrieved by a PubMed search. This entity is an interdisciplinary challenge because of its presentation with sudden cardiac arrest without any immediately obvious cause, the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, including cardio - pulmonary resuscitation. With a mortality of 11% to 44%, it is among the leading direct causes of maternal death. Amniotic fluid embolism (AFE) is a life-threatening obstetric complication that arises in 2 to 8 of every 100 000 deliveries. KEY POINTS: Amniotic fluid embolism (AFE) is a rare cause of maternal collapse during or immediately after delivery, seen in approximately 1.9 to 6.1 per 100,000 births (Pacheco et al.
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