Several risk factors were related to common obstetric interventions: induction of labor, operative vaginal delivery, and cesarean delivery. Prenatal risk factors included advanced maternal age, multiple pregnancy, gestational diabetes, polyhydramnios, placenta previa, and placental abruption. Interestingly, the main risk factors identified in this study were consistent across all three case definitions. The latter two definitions were modified to harmonize the data collected across international sites. For these reasons, Fitzpatrick and coauthors examined risk factors, prognosis, and clinical management of AFE using three different definitions: the most liberal definition proposed by the United Kingdom Obstetric Surveillance System (UKOSS), a consensus-driven definition developed by the International Network of Obstetric Survey Systems (INOSS), and the most restrictive definition developed by Clark and colleagues and used by the Amniotic Fluid Embolism Registry in the United States. īecause AFE is a diagnosis of exclusion, a precise case definition is difficult to establish. Given the acuity and complexity of AFE signs and symptoms, an immediate response by a multidisciplinary team including experienced specialists in obstetrics, maternal–fetal medicine, anesthesia, intensive care, and hematology is probably key for survival, as observed by Fitzpatrick and colleagues. Myocardial infarction and other conditions can also resemble AFE. Consumptive coagulopathy without cardiorespiratory symptoms is sometimes recognized as a forme fruste of AFE, but it is important to exclude other possible diagnoses, such as septic shock or coagulopathy caused by, rather than the cause of, excessive bleeding. Premonitory symptoms such as tingling, shortness of breath, and agitation may occur before the signs and symptoms of cardiovascular collapse.

The clinical signs and symptoms of AFE include a rapid deterioration of maternal condition, cardiac arrest or arrhythmia, hypotension, respiratory distress, coagulopathy and massive hemorrhage, and acute fetal compromise. In a new international study published in PLOS Medicine, Kathryn Fitzpatrick and colleagues provide valuable clinical information about this rare complication, which occurs in 2–8 of 100,000 pregnancies. Owing to its uncertain etiology, varying symptoms, rapid onset, and high fatality rate, amniotic fluid embolism (AFE) is one of the most challenging obstetric emergencies.

Aok protocol amniotic fluid embolism