Amniotic Fluid Embolism

Learning Objectives

  • Describe the pathophysiology of amniotic fluid embolism.

  • List risk factors for amniotic fluid embolism.

  • Identify clinical presentation of amniotic fluid embolism.

  • Describe a management strategy for amniotic fluid embolism.

Amniotic fluid embolism is a fortunately rare obstetric emergency. However, if mothers are to survive this catastrophic event, clinicians must recognize it quickly and manage it very aggressively.


Amniotic fluid embolism occurs when there is enhanced communication between the amniotic cavity and maternal circulation. This allows amniotic fluid to enter the maternal circulation where it triggers a systemic inflammatory response ( Fig. 25.1 ). In the first hour, this typically presents as pulmonary hypertension and right ventricular failure. This is followed by left ventricular failure. The resultant hypotension and hypoxemia trigger multisystem organ failure. Concurrent activation of the coagulation cascade results in disseminated intravascular coagulation.

Fig. 25.1

Symptoms of amniotic fluid embolism.

Technical and nontechnical skills in management of amniotic fluid embolism.

Risk Factors

  • Multifetal gestation

  • Advanced maternal age

  • Operative delivery

  • Eclampsia

  • Polyhydramnios

  • Cervical laceration

  • Uterine rupture

  • Placenta previa

  • Amnioinfusion

Clinical Presentation

There are no diagnostic tests or laboratory findings for amniotic fluid embolism. It is a clinical diagnosis based on the following findings:

  • Sudden, unexplained respiratory distress

  • Hypotension

  • Cardiac arrest

  • Seizure-like activity

  • Fetal bradycardia

  • Disseminated intravascular coagulation

  • Uterine atony

Differential Diagnosis

  • Pulmonary embolism

  • Congestive heart failure

  • Myocardial infarction

  • Anaphylaxis

  • Placental abruption

  • Sepsis with hypotension

  • Placental abruption

  • Anesthetic complications


The goals of management are stabilization of the mother and rapid delivery of the fetus ( Table 25.1 ).

Table 25.1

Management of Amniotic Fluid Embolism 1,2


  • Goal MAP is >65 mm Hg

  • Treat hypotension with vasopressors

    • Norepinephrine 0.05-3.3 μg/kg/min

    • Dobutamine 2.5-5.0 μg/kg/min

  • Avoid excessive fluid administration

  • If cardiac arrest, follow ACLS algorithms

  • Institute post-arrest hypothermia only if there is no clinical evidence of coagulopathy


  • Supplemental oxygen should be titrated to maintain SpO 2 at 94–98%

  • Avoid hyperoxia after cardiac arrest (may worsen ischemia-reperfusion injury)

  • Intubation is commonly needed


  • Aggressive blood replacement (including red blood cells, fresh frozen plasma, cryoprecipitate, and platelets) is critical

  • Consider activating massive transfusion protocol

  • Replacement can be initiated before clinical evidence of coagulopathy


  • If vaginal delivery is imminent, can proceed with assisted second stage

  • If not, proceed with immediate cesarean

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Apr 6, 2024 | Posted by in OBSTETRICS | Comments Off on Amniotic Fluid Embolism

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