Amniotic fluid embolism (AFE) is a rare obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and trigger an allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and coagulopathy. Amniotic fluid embolism (AFE) is a pregnancy complication that causes life-threatening conditions, such as heart failure. It can affect you, your baby, or both of you.
The first stage of AFE usually includes cardiac arrest and rapid respiratory failure. Cardiac arrest occurs when your heart stops working and you lose consciousness and stop breathing. Rapid respiratory failure occurs when your lungs cannot supply enough oxygen to your blood or remove enough carbon dioxide from it.Several factors have been associated with amniotic fluid embolism syndrome. They include precipitous or tumultuous labor, advanced maternal age, cesarean and instrumental delivery, placenta previa and abruption, grand multiparity (≥5 live births or stillbirths), cervical lacerations, fetal distress, eclampsia, and medical induction of labor . AFE is a diagnosis of exclusion and is made clinically.
While approximately 70% of maternal deaths caused by AFE are a result of cardiopulmonary collapse, the pathophysiology of the cardiopulmonary disturbance is not clearly understood. Almost all human hemodynamic data post-AFE were collected 1 h or more after the event , yet 25%–50% of the parturients die within the first hour of clinical presentation. We present a case in which transesophageal echocardiography (TEE) was performed during the early course of AFE. The TEE findings provide additional information regarding the cardiopulmonary pathophysiology occurring during the very early phase of AFE.