Steiner and Lushbaugh also described experimental evidence of the syndrome in dogs and rabbits following intravenous injection of human amniotic fluid rich in vernix or meconium which leads to a similar clinical presentation as described in the autopsies of eight parturients associated with plugging of the pulmonary vessels by squamous cells, presumably of fetal origin. They theorized that amniotic fluid was forced into the maternal circulation during contractions.

Although manifestations of AFE may be along a continuum from mild and transient to severe and fulminant cardiopulmonary collapse, prompt diagnosis and aggressive management improve maternal outcomes ( 12).Īlthough Meyer first reported a case of stillbirth associated with maternal death and AFE to the lungs in 1926 ( 13), Steiner and Lushbaugh first described the AFE syndrome in a case report of eight women who died unexpectedly from obstetric shock associated with pathologic evidence of AFE of fetal material in maternal lung blood vessels in 1941 ( 14).

However, new strategies and innovative approaches to management and treatment of AFE, including the use of an intra-aortic balloon pump with extracorporeal membrane oxygenation (ECMO) ( 6, 7, 8), cardiopulmonary bypass ( 9), inhaled nitric oxide ( 10), right ventricular assist devices ( 8), recombinant factor VIIa (rFVIIa) ( 7, 11), have been reported with success and should be considered when all established, “standard of care” management approaches have failed. Despite aggressive and early management, maternal and fetal morbidity and mortality remained unacceptably high between 60% and 80% through the mid-1990s ( 5). However, early diagnosis, expeditious resuscitation and delivery, and management of sequelae by a team approach including anesthesiologist, obstetrician, and intensivist may improve maternal and fetal outcomes. Although the majority of deaths from AFE are not preventable, it is up to the anesthesia care provider to have a thorough understanding of the anesthetic implications of AFE in order to immediately diagnose and treat AFE during pregnancy and delivery.ĪFE is thought to be a rare but often fatal complication of pregnancy whose onset can neither be predicted nor prevented ( 4). In the triennium 2006 to 2008, CMACE reported AFE, the fourth leading cause of direct maternal deaths in the United Kingdom. An estimated 5% to 15% of all maternal deaths in Western countries are due to AFE. Combined AFE and pulmonary thromboembolism account for approximately 25% of maternal deaths ( Table 22-1). Clark confirmed that AFE is one of the leading causes of maternal death in addition to preeclampsia, pulmonary thromboembolism, obstetric hemorrhage, and cardiac disease ( 3). According to a study by the Centers for Disease Control and Prevention (CDC) of pregnancy-related mortality in the United States between 19, the leading causes of maternal deaths are hemorrhage, pregnancy-related hypertensive disorders, pulmonary embolism, amniotic fluid embolism (AFE), infection, and pre-existing chronic conditions, such as, cardiovascular disease ( 2).

Amniotic fluid embolism pitocin