Medical Responsibility in the Operating Room: The Example of an Amniotic Fluid Embolism

Amniotic fluid embolism (AFE) continues to be one of the most feared complications of pregnancy. A healthy 32-year-old woman died during delivery after a normal 39-week third pregnancy. The family filed a complaint with a criminal court as the causes of death appeared unclear. No risk factor associated with AFE was identified. Clinical presentation was typical, including sudden onset of cardiovascular and respiratory symptoms. Autopsy confirmed the histological diagnosis of amniotic embolism and excluded an iatrogenic cause of death or anesthetic malpractice. This article highlights the value of both antemortem records and histological features in establishing the diagnosis of AFE and demonstrates the fundamental importance of autopsy in an unexpected death related directly or indirectly to a medical procedure. Maternal death during delivery is rare, but traumatic for the medical teams. When a patient dies during anesthesia or immedi- ately following a surgical procedure, the liability of the anesthetic and gynecological teams may be sought. This attitude is generally explained by the fact that it is impossible for the medical team to establish the immediate cause of death with any certainty. The death of the mother is experienced as a tragedy, especially as the women giving birth are young and healthy (1). In the volatile situa- tion that follows unexpected death, the risk of legal proceedings is high, and autopsy may be indicated to investigate the causes of death and the possibility of medical liability. When death occurs during anesthesia and surgery, it has been observed that the rela- tives and ⁄ or their counsel frequently tend to consider the medical chart data as inadequate or untrustworthy (2,3).