Amniotic fluid embolism

Abstract

Identify the risk factors for amniotic fluid embolism (AFE). Discuss the pathophysiological processes underlying the clinical features of AFE. Differentiate between more common causes of maternal collapse and AFE. Interpret different diagnostic tests in the context of AFE, including new markers and specialised investigations. Implement prompt management of a woman suspected to have AFE. Amniotic fluid embolism (AFE) is a serious but rare complication of pregnancy with significant morbidity and mortality. AFE can present as a sudden and unexplained maternal collapse secondary to profound hypotension or hypoxaemia, and disseminated intravascular coagulation (DIC). Its rarity makes it difficult to study, and this is the main reason for gaps in our understanding of the condition. Since 2005, the UK Obstetric Surveillance System (UKOSS) has collected data on all AFE cases in the United Kingdom.

The Role of Echocardiography in Amniotic Fluid Embolism: A Case Series and Review of the Literature

“…Immune-mediated prothrombotic substance release in response to amniotic fluid contents is thought to cause disseminated intravascular coagulation (DIC), further contributing to maternal fatality. 1 As there is no specific treatment for AFE, early recognition and timely initiation of cardiovascular supportive therapies are crucial for survival. To date, there is no definitive test to confirm AFE and it is essentially a clinical diagnosis by exclusion.…”

“…Acute pulmonary hypertension from mechanical and/or immunogenic vasospasm leads to elevated RV pressure and can precipitate right heart failure, which clinically manifests as acute hypotension. Immune-mediated prothrombotic substance release in response to amniotic fluid contents is thought to cause disseminated intravascular coagulation (DIC), further contributing to maternal fatality 1…”