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Amniotic fluid embolism is entrance of amniotic fluid and fetal cells into the maternal circulation initiating an abnormal response.
Amniotic fluid embolism is a rare obstetric emergency. It usually occurs during late pregnancy; risk is increased with cesarean delivery, advanced maternal age, abruptio placentae, abdominal trauma, placenta previa, and forceps delivery. Amniotic fluid embolizes to the maternal circulation, causing tachycardia, hypotension, respiratory failure, disseminated intravascular coagulation, and often rapid maternal death. Autopsy may show fetal squamous cells and hair in the pulmonary circulation.
About 20% of affected women die, although mortality estimates often vary widely. Survival depends on early recognition and immediate institution of treatment.
Diagnosis is clinical.
Treatment is supportive. It includes transfusion of RBCs (as needed to replace lost blood), fresh frozen plasma and clotting factors (as needed to reverse the coagulopathy), and ventilatory and circulatory support, with inotropic drugs as needed.
Last full review/revision December 2008 by Julie S. Moldenhauer, MD
Content last modified December 2008
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