Amniotic fluid embolism: An obstetrical enigma

Amniotic fluid embolism (AFE) has been classically defined as an event that occurs acutely during labor and delivery or immediately postpartum, presenting with hypoxia and hypotension leading to cardiovascular collapse, altered mental status and coagulopathy. Since AFE presents similarly to several other obstetrical emergencies, definitive diagnosis is difficult and can result in a delay in diagnosis and initiation of appropriate therapy. Myriad signs and symptoms are associated with occurrence of AFE, but five clinical signs have traditionally been associated with AFE: respiratory distress, cyanosis, cardiovascular collapse, coma and hemorrhage. Although the diagnosis of AFE is a diagnosis of exclusion, if a woman presents with acute shock and cardiovascular collapse accompanied by respiratory distress during labor or shortly after delivery in the absence of any other obvious cause, the diagnosis of AFE is likely. This review will examine the diagnosis, pathophysiology and management of AFE as an obstetrical emergency.