Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. 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.
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. The exact causes of amniotic fluid embolism are still unknown because it is so rare. The prognosis and mortality of AFE have improved significantly with early diagnosis of AFE and prompt and early resuscitative measures. Although rare in an absolute sense, amniotic fluid embolism is identified as the leading cause of maternal mortality in many developed countries. Its treatment requires immediate, optimal interdisciplinary cooperation. The signs and symptoms of amniotic fluid embolism can sometimes overlap with other childbirth complications. Treatment is based on high quality CPR maneuvers, airway management and intravenous access for fluid resuscitation and blood transfusion. Amniotic fluid embolism is characterized by the sudden onset of hypotension, hypoxia, and coagulopathy during, or immediately after, delivery. 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.
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