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Amniotic Fluid embolism

Amniotic fluid embolism is one of the most catastrophic complications of pregnancy.
The etiology was thought to be embolic in nature, but more recent evidence suggests an immunologic basis.
it occurs in:

  • 70% during vaginal delivery 
  • 19% during cesarean section 
  • 11% immediately following vaginal delivery
  • Rare cases have been reported after midtrimester termination, transabdominal ambiocentesis, and trauma.   

Mechanism of disease is poorly understood.  Classic presenting symptoms include respiratory distress, altered mental status, hypotension, and coagulopathy (DIC).   There are no lab tests to confirm the diagnosis.  Management is supportive. In cases in which a malgnant arrhythmia is present for greater than 4 minutes, perimortem cesarean delivery should be considered.
Recently, aggressive and successful management of amniotic fluid embolism with recombinant factor VIIa and a ventricular assist device, inhaled nitric oxide, cardiopulmonary bypass and intraaortic balloon pump with extracorporeal membrane oxygenation have been reported and should be considered in select cases.

 However, despite intensive resuscitation, outcomes are frequently poor for both infant and mother
Source
A & A May 2009 vol. 108 no. 5 1599-1602
Stafford, I.  Sheffield, J.  "Amniotic Fluid Embolism"  Obstetrics and Gynecology Clinics of North America.  2007.
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