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Despite its name, we're not really sure what's happening in amniotic fluid embolisms. We think that some amniotic fluid and fetal cells gets into the parental blood vessels, and this causes a cytokine storm that leads to systemic vascular collapse, but we're still figuring it out. This is a clinical diagnosis, and while rare (1-3/100000), it can be extremely fatal, ranging anywhere from 10%-60% mortality depending on what study you're looking at. Even worse, some studies show that up to 80% of patients arrest at some point after their diagnosis, many within 5 minutes of their symptoms beginning.
Key times to look for this are postpartum AND post-abortion (though post-abortion is even rarer).
What you're looking for:
- Rapid cardiovascular and respiratory collapse (hypotension, SOB) - look on echo for R-sided failure
- DIC not because of hemorrhage (In this case, DIC comes first, then hemorrhage, not the other way)
- Onset within 30 minutes of placental delivery
- No fever during labor
Often times, there will be neurological symptoms like AMS, seizures, and confusion.
There is no cure, so we treat the symptoms: use your vasopressors! Norepinephrine is our go-to, but keep your inotropic agents close, because of your right heart failure (dobutamine, milrinone). You can also try iNO therapy, MTP, and ECMO if you're at a facility capable of it.
References
Coggins AS, Gomez E, Sheffield JS. Pulmonary Embolism and Amniotic Fluid Embolism. Obstet Gynecol Clin North Am. 2022;49(3):439-460. doi:10.1016/j.ogc.2022.02.015