Amniotic fluid embolism collapse: diagnosis, biphasic course and resuscitation

Meet the patient

A 35-year-old multiparous woman collapses at full dilatation — SpO2 70 percent, blood pressure unrecordable, then blood begins oozing from every IV site. No blood sample confirms amniotic fluid embolism: this is AFE until proven otherwise, and resuscitation starts now, not after histology returns.^[1]

Two facts. AFE is a clinical diagnosis of exclusion, and it is biphasic — cardiorespiratory collapse first, then consumptive coagulopathy. Resuscitate now, support the RV, replace fibrinogen, deliver if undelivered.^[2]

References6ShowHide

1. [1]Pacheco LD, Saade G, Hankins GD, et al. Amniotic fluid embolism: diagnosis and management Am J Obstet Gynecol, 2016.PMID 26987420
2. [2]Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies Am J Obstet Gynecol, 2016.PMID 27372270
3. [3]Pacheco LD, Clark SL, Klassen M, et al. Amniotic fluid embolism: principles of early clinical management Am J Obstet Gynecol, 2020.PMID 31376394
4. [4]Wiseman D, Simard C, Yang SS, et al. Echocardiography findings in amniotic fluid embolism: a systematic review of the literature Can J Anaesth, 2023.PMID 36307749
5. [5]Viau-Lapointe J, Filewod N Extracorporeal Therapies for Amniotic Fluid Embolism Obstet Gynecol, 2019.PMID 31599831
6. [6]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509