Amniotic Fluid Embolism: Report of a Fatal Case

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In the Magee-Womens Hospital, amniotic fluid embolism (AFE) is the leading cause of maternal death, with an incidence of 1:17,000. In a recent fatal case, the patient, who had a rapid course of labor, suddenly developed hypotension, cyanosis, and convulsions. These manifestations are highly suggestive of AFE if aspiration and toxic reaction to local anesthetics are excluded. The following points should be considered in resuscitating these cases: (1) central venous pressure monitoring aids diagnosis and regulation of intravenous (I.V.) fluids; (2) calcium should be used when magnesium has been administered; (3) isoproterenol and oxygen help to relieve pulmonary vasoconstriction and improve cardiac condition, but isoproterenol may reduce blood pressure; (4) positive-pressure respiration and corticosteroids decrease the chances of acute pulmonary edema.

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