If AFE presents intrapartum, the fetus should be delivered immediately to support maternal hemodynamics. Correcting hypoxemia and hypotension is paramount to prevent further sequelae to the mother and the fetus. The management of amniotic fluid embolism syndrome is supportive care. The constellation of signs and symptoms in a pregnant woman who experiences the typical symptomology and a high degree of suspicion usually are sufficient to make the diagnosis of AFE. The diagnosis of this syndrome is difficult and AFE remains a diagnosis of exclusion since there are no laboratory or radiographic tests which definitively confirm the diagnosis. Severe and refractory hypoxemia results from significant ventilation/perfusion mismatching as well as from both cardiogenic pulmonary edema associated with acute left heart failure and noncardiogenic pulmonary edema (adult respiratory distress syndrome). The classic presentation of this syndrome is cardiopulmonary collapse usually complicated by respiratory failure, cardiogenic shock, disseminated intravascular coagulation (DIC), and neurologic changes including seizures and coma. It is also seen more frequently in preeclamptic patients and in women who have Cesarean sections. The syndrome occurs with greater frequency in parturients who are older and multiparous, have twin pregnancies, and experience difficult labors. The exact cause of this syndrome is not known although it is widely suspected that there may be an immune etiology causing an anaphylactoid-like reaction with complement activation. Amniotic fluid embolism (AFE) is a rare clinical syndrome that occurs intrapartum or immediately postpartum.
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