|February 2003 · Vol. 15, No. 2
Manging amniotic fluid embolism
The rarity of AFE and the fact that presentation is acute make it difficult to establish an optimal therapy. An expert reviews findings from selected series and offers guidelines on managing this life-threatening collapse.
Dr. Tuffnell is a consultant in OBG for Bradford Hospitals NHS Trust in Yorkshire, England.
Amniotic fluid embolism is a leading cause of maternal mortality in developed countries.
It presents with maternal collapse or seizures, or occasionally fetal distress.
Resuscitation must be prompt and multidisciplinary, including delivery if necessary.
There is no specific therapy except intensive support with transfusion.
Mortality may not be as high as previously thought, since milder cases do occur.
A mniotic fluid embolism (AFE) is a dramatic and perplexing condition. Within moments of the appearance of symptoms, a gravida’s life is at stake, and both maternal and fetal deterioration are rapid. Further, because the diagnosis isn’t always clear, the hospital team must rule out other possible etiologies while trying to prevent respiratory arrest and hemorrhage. The relative rarity of AFE adds to the difficulty of deciphering its pathophysiology. That rarity, coupled with the complexity of management, may explain why AFE remains a leading cause of maternal death. In the United Kingdom over the past 15 years, AFE has been responsible for 8.4% of maternal deaths. In the United States and Australia, it has been associated with 7.5% to 10% of these deaths.1-3
Fortunately, a gloomy prognosis may no longer be inevitable. Over the past 20 years or so, mortality rates for AFE appear to have dropped. Still, when this condition presents, immediate action is vital if there’s any hope of saving mother and fetus. Here, I present clinical features that may signal an AFE and describe various management strategies outlined in the literature.