Amniotic fluid embolism (AFE)

Amniotic fluid embolism (AFE) is a rare and catastrophic condition unique to pregnancy that should be considered in the differential diagnosis for any sudden cardiorespiratory collapse or seizure during this period. It commonly presents with hypotension, hypoxia, and coagulopathy. The true incidence of AFE is unknown since it is a diagnosis of exclusion, often made postmortem, but must include documentation of coagulopathy. US estimates range from 1.7 to 5.4 per 100,000 live births with mortality rates as high as 80%, usually occurring within the first hours of onset. Permanent neurologic dysfunction affects up to 85% of survivors. AFE is a diagnosis of exclusion. Myocardial infarction, pulmonary embolism, anaphylaxis, eclampsia, and sepsis should be considered on the differential as well.