Management of Amniotic Fluid Embolism

Amniotic fluid embolism (AFE) is a rare clinical syndrome that occurs intrapartum or immediately postpartum. The exact cause of this syndrome is not known although it is widely suspected that there may be an immune etiology causing an anaphylactoid-like reaction with complement activation. The syndrome occurs with greater frequency in parturients who are older and multiparous, have twin pregnancies, and experience difficult labors. It is also seen more frequently in preeclamptic patients and in women who have Cesarean sections. The classic presentation of this syndrome is cardiopulmonary collapse usually preceded by respiratory failure, cardiogenic shock, disseminated intravascular coagulation (DIC), and neurologic changes including seizures and coma. Severe and refractory hypoxemia results from ventilation/perfusion mismatching as well as from cardiogenic pulmonary edema associated with acute left heart failure. The diagnosis of this syndrome is difficult and AFE remains a diagnosis of exclusion since there are no laboratory or radiographic tests which confirm the diagnosis. The constellation of signs and symptoms in a pregnant woman who experiences the typical symptomology and a high degree of suspicion usually are sufficient to make the diagnosis of AFE.