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Amniotic Fluid Embolism (AFE)

About

Amniotic fluid embolism (AFE) is a rare and unexpected birth complication that may occur when a mother suffers an allergic-like response to amniotic fluid that may enter her bloodstream during labor or shortly after delivery. The response can be life threatening to both mother and to her baby(ies) if she develops this before delivery. It can cause maternal respiratory and cardiac complications as well as blood clotting problems that can lead to uncontrolled bleeding. AFE is estimated to affect 1 in every 40,000 deliveries.

Although rare, clinicians should be prepared for this obstetric emergency and be aware of the clinical presentation and proficient in their understanding of the pathophysiology, treatment, and diagnosis of amniotic fluid embolism.

Amniotic Fluid Embolism is difficult to diagnose. If the doctor suspects AFE, immediate action and treatment must be taken to address the potentially life threatening complications.

 

Signs and Symptoms

Amniotic fluid embolism might develop suddenly and rapidly. Early signs and symptoms might include:

  • Increased anxiety
  • Agitation
  • Impending sense of doom
  • Confusion
  • Nausea or vomiting
  • Chills
  • Skin discoloration
  • Shortness of breath
  • Fetal distress
  • Abnormal vital signs

Which can lead to more serious and acute symptoms:

  • Loss of consciousness
  • Seizure and/or cardiopulmonary arrest
  • Bleeding from the uterus, cesarean incision or intravenous (IV) sites (disseminated intravascular coagulopathy)

 

Resources

AFE Clinical Fact Sheet (October 2019)

Resources for Parents and Families

Amniotic Fluid Embolism Foundation provides Crisis Resources, family support, support groups

Resources for Clinicians

Articles

Amniotic fluid embolism: diagnosis and management. Society for Maternal-Fetal Medicine (SMFM) with the assistance of Luis D. Pacheco, MD; George Saade, MD; Gary D. V. Hankins, MD; Steven L. Clark, MD: https://www.sciencedirect.com/science/article/pii/S0002937816004749.

Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Clark SL, Romero R, Dildy GA, et al. Am J Obstet Gynecol. 2016; 215:408-412: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072279/.

Reproductive decisions after the diagnosis of amniotic fluid embolism.  Moaddab, A, Klassen, M, Clark SL, et al. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017;211:33–36: https://www.ejog.org/article/S0301-2115(17)30059-3/abstract.

Amniotic fluid embolism. Clark SL. Obstet Gynecol. 2014;123:337-348: https://www.ncbi.nlm.nih.gov/pubmed/24402585.

Amniotic fluid embolism: an evidence-based review. Conde-Agudelo A, Romero R. Am J Obstet Gynecol. 2009;201:445.e1-445.13: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401570/.

For more information on AFE including research, crisis resources, and support groups, visit the Amniotic Fluid Embolism Foundation website

 

Personal Story

Picture of Diana, a survivor of an amniotic fluid embolism, and her family

Read Diana's story as well as other AFE stories.