Recent Perspective of Amniotic Fluid Embolism: A Review Article

Abstract

Background: Amniotic fluid embolism (AFE) is a rare obstetric emergency with unclear aetiology, pathophysiology, diagnosis and management. The true incidence is unclear and diagnosed largely by exclusion. It can neither be predicted nor prevented and its management is fraught with controversy. Objective: To provide clinicians with current knowledge regarding the epidemiology, pathophysiology and management of AFE. Methods: This was a descriptive review of AFE. We searched several databases (Medline, Google scholar and Pubmed) with keywords, amniotic fluid, amniotic fluid embolism, amniotic fluid embolus and sudden postpartum collapse from inception to June 2014. Results: Data regarding the presence of risk factors for AFE are inconsistent, complex and contradictory. No risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of AFE. Further understanding of this syndrome has been hampered by lack of universally accepted diagnostic criteria. Diagnosis of AFE is clinical, largely by exclusion, and maternal treatment is primarily supportive and not causative. Mortality is still high despite improved modalities for diagnosing AFE, and better intensive care support facilities. Conclusion: AFE is a rare and dreadful obstetric emergency with a high morbidity and mortality rate. Our understanding of its aetiology and pathophysiology is incomplete and the criteria used to make its diagnosis are controversial. Inspite of advances in the care of critically ill patients, no management interventions have been found to improve survival or long-term outcome of patients with AFE.