Amniotic fluid embolism (afe) during labor resulting in brain damage, king abdul aziz hospital, jeddah, Saudi Arabia

A 27 year old primigravida underwent caesarean section because of fetal distress following induction of labour. Intra-operative patient become dyspneic , lost conscious and unrecordable blood pressure. Subsequently, she developed respiratory failure requiring mechanical ventilation and dilated left ventricle . cardiac arrest followed after these events. The likely diagnosis was amniotic fluid embolism (AFE), a rare complication of pregnancy with a variable presentation, ranging from cardiac arrest and death through to mild degrees of organ system dysfunction with or without coagulopathy. The differential diagnosis includes pre-eclamptic toxaemia/pregnancy-induced hypertension, anaphylaxis and pulmonary embolism. The course of these events was so rapid and catastrophic, which was consistent with AFE. Thus, we report this case precisely and review pathophysiology, diagnosis, treatment of AFE by referring to up-to-date literatures. There is no diagnostic test for AFE; the finding of fetal elements in the maternal circulation is non-specific. Historically, AFE was thought to induce cardiovascular collapse by mechanical obstruction of the pulmonary circulation. It is now thought that a combination of left ventricular dysfunction and acute lung injury occur, with activation of several of the clotting factors. An immunological basis for these effects is postulated. There is no specific therapy and treatment is supportive. The mortality of the condition remains high.