Amniotic fluid embolism (AFE) is a rare, catastrophic syndrome that presents during labor and delivery or immediately
postpartum. Efforts to develop a clinical diagnostic test are ongoing; however the diagnosis still relies on rapid
bedside evaluation and depends on the exclusion of other diseases. Classically, the diagnosis was made at autopsy, with
the demonstration of squamous cells or debris in the maternal pulmonary vasculature. Clinico-pathological correlations
have strengthened the evidence for a role of the immune system in the pathogenesis of AFE and have lead to the development
of new laboratory tests, such as the serum tryptase and complement measurements, which should provide scientific
support for the presumed immunological mechanism of AFE. Recently, studies on the effects of amniotic fluid (AF)
on platelet - neutrophil aggregation and neutrophil/platelet activation have opened new insight in the comprehension of
the mechanisms underlying AFE, suggesting that a severe inflammatory response might have a paramount causative role,
so opening new diagnostic and therapeutic perspectives. Considering the complex interplay between the different mechanisms
involved in the pathogenesis of AFE, the diagnosis still arises from a complex diagnostic puzzle in which clinical,
macroscopic, laboratory, histological and immunohistochemical data converge toward AFE.
Keywords: Amniotic fluid embolism syndrome, complement activation, diagnosis, immunological pathway, inflammatory
response, neutrophil activation, platelet - neutrophil aggregation.
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