Amniotic fluid embolism: How can we avoid the worst?

Abstract

Amniotic fluid embolism (AFE) is a catastrophic syndrome typically occurring during labor and delivery or immediately postpartum. The pathophysiology of this entity is incompletely understood. The diagnosis of AFE is primarily based on the clinical observations even if not uniform. The classic triad of sudden hypoxia, hypotension, and coagulopathy forms the hallmark of AFE diagnosis. The primary management goal includes rapid maternal cardiopulmonary stabilization with treatment of hypoxia and maintenance of vascular perfusion. We describe the clinical case of a 36-year-old patient admitted for emergency caesarean section for acute fetal distress under spinal anaesthesia. She presents a few minutes after fetal extraction a cardiovascular collapse, sudden respiratory distress and disturbance of consciousness on a massive amniotic fluid embolism. We discuss also the modalities of management of this serious complication.