Amniotic fluid embolism: A narrative review of current concepts and future perspectives

Abstract

Amniotic fluid embolism (AFE) is a rare yet devastating complication of pregnancy. The outcomes are often poor, proving fatal for both mother and neonate. The incidence and mortality rate due to AFE is quite high even in developed countries and may be much higher in developing countries. Data from developing countries are unavailable. There is no uniform internationally accepted diagnostic criterion for AFE. No single diagnostic test has been found sufficient to suspect AFE in the early stages. Recently, complement system activation and an anaphylactoid reaction in the uterine tissue have been proposed in relation to its pathophysiology. In few cases, the use of complement C1 inhibitor with tranexamic acid, atropine, ondansetron, ketorolac therapy, and extracorporeal membrane oxygenation was observed to be very effective for early management. The studies on the pathophysiology of AFE are still limited. Further research is required to know the mechanism of this disease. Reliable rapid diagnostic tests are much needed at this stage. It is important to investigate the histopathology of tissues affected by AFE and find the origin of the disease in the maternal system. This review intends to highlight the best known and the unknown aspects of AFE relevant for future research purposes to minimize the fatality/mortality rate due to AFE, which remains an undiagnosed cause.

Keywords

• amniotic fluid embolism
• anaphylactoid reaction
• disseminated intravascular coagulation
• maternal mortality
• pregnancy