Title:Amniotic Fluid Embolism: Review
VOLUME: 14 ISSUE: 14
Author(s):Greco Pantaleo, Nappi Luigi, Trezza Federica, Storelli Paola, Neri Margherita and Mahmood Tahir
Affiliation:Consultant Obstetrician & Gynaecologist, Victoria Hospital, Kirkcaldy, Senior Lecturer (Hon) University of Endinburgh and St Andrews, Scotland.
Keywords:Amniotic fluid embolism, clinical manifestations, delivery hemorrhage, fatal cases, fetal morbidity and mortality,
maternal morbidity and mortality, risk factors.
Abstract:Amniotic fluid embolism is a rare but dreadful syndrome in Obstetrics, which happens, in most of the cases, in
the peripartum period. The actual “embolisation” of the pulmonary vessels does not explain the whole picture of the syndrome.
An immune mechanism, similar to an anaphylactic reaction, is more convincingly the background of the event, but
the pathogenesis is still ill-defined. Similarly the initial symptoms are difficult to interpret and distinguish from other
acute and life-threatening emergencies (i.e. pulmonary embolism, placental abruption, septic shock, stroke, myocardial
ischemia, etc.), therefore the diagnosis is one of exclusion, very often on postmortem report. Thus the prevalence of the
disease is difficult to establish, most of the reports being postmortem cases or National Registries data. These data, based
either on autopsy series or on registries, are non representative of the true prevalence of the event and obviously confusing
for the correct understanding of the disease process. Risk factors are all those conditions or manouvres, which contemplate
a breech in the maternal-fetal barrier. Again, given the rarity of the syndrome, no single event is clearly identifiable
as a case-effect risk factor. Prognosis, which is obviously biased by the reporting system, is particularly grim both in terms
of survival and morbidity. The symptoms being often elusive at the beginning, but rapidly and progressively catastrophic,
a multidisciplinary team approach is warranted in order to provide the best chance of survival both for mother and baby.
Immediate and aggressive resuscitation is, therefore, advised whenever a mother in labour or in the early postpartum period
experiences a sudden collapse.
