Overview
Introduction
Amniotic fluid embolism (AFE) is a rare, abrupt obstetric emergency in which maternal immune and inflammatory activation produces pulmonary vasoconstriction, cardiac failure, sh...
Amniotic fluid embolism (AFE) is a rare, abrupt obstetric emergency in which maternal immune and inflammatory activation produces pulmonary vasoconstriction, cardiac failure, shock, and often rapidly evolving disseminated intravascular coagulation (DIC). The name can mislead: AFE is not diagnosed by proving a mechanical plug of amniotic material in the pulmonary arteries, and there is no confirmatory bedside assay. The pattern matters more than any isolated result. A patient may develop sudden dyspnoea, hypoxaemia, hypotension, agitation, seizure-like activity, or cardiac arrest during labour or shortly after birth. Coagulopathic bleeding may follow within minutes, including uterine atony that does not respond as expected, persistent oozing from puncture sites, or haemorrhage out of proportion to the visible obstetric source. For a Canadian nurse practitioner, the immediate task is parallel action: support maternal oxygenation and circulation, activate the local obstetrical massive haemorrhage and cardiac-arrest pathways, obtain early coagulation studies, and bring together obstetrics, anaesthesia, critical care, transfusion medicine, respiratory therapy, nursing, and neonatal teams. Treatment cannot wait for a test that confirms AFE.