Chapter 40 - Anaphylactoid syndrome of pregnancy (amniotic fluid embolus)

Summary

Amniotic fluid embolism (AFE) is a rare condition with a poorly understood pathophysiology. It is a condition that causes significant maternal and fetal morbidity and mortality. Medical inductions of labor, advancing maternal age, particularly in women from ethnic minority groups, cesarean section, and multiple pregnancy have all been demonstrated as risk factors for AFE. Most AFE occurs on the labor ward around the time of delivery. Once the baby has been delivered or if the AFE occurred after delivery, then when the woman is stable she will need immediate transfer to intensive care unit. Aggressive resuscitation is the keystone to a good outcome for a woman and her fetus. Development of disseminated intravascular coagulation is almost synonymous with AFE. The role of thromboprophylaxis for 6 weeks postpartum is unclear in AFE, but risk factors should be assessed on an individual basis, and a decision is made at discharge from hospital.