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Amniotic fluid embolism

Discover the facts about the little-known killer amniotic fluid embolism

Medicine's best-kept secret is a mysterious disease known as amniotic fluid embolism (AFE). It comes out of nowhere to kill mothers and their babies, usually during childbirth. According to medical literature, as many as half of the women it affects die within an hour of the onset of symptoms and many of the rest die the same day or suffer permanent neurological impairment.

What is AFE?
AFE is a rare obstetric emergency in which amniotic fluid, foetal cells, hair or other debris enters the mother's blood stream via the placenta and triggers an allergic reaction. This allergic reaction then results in cardiorespiratory (heart and lung) collapse.

The condition is so rare that most doctors will never encounter it in their professional careers and as a result the exact process is poorly understood. However, it is believed that once the fluid and foetal cells enter the maternal pulmonary circulation a two-phase process occurs:

First phase: The patient experiences acute shortness of breath and hypertension (extremely high blood pressure). This rapidly progresses to cardiopulmonary arrest as the chambers of the heart fail to dilate and there is a reduction of oxygen to the heart and lungs. Not long after this stage the patient will lapse into a coma.

Second phase: Although many women do not survive beyond the first stage, about 40 per cent of the initial survivors will pass onto the second phase. This is known as the hemorrhagic phase and may be accompanied by severe shivering, coughing, vomiting and the sensation of a bad taste in the mouth. This is also accompanied by excessive bleeding as the blood loses its ability to clot. There is also foetal distress present. As hypoxia (the reduction of the oxygen supply) progresses the foetal heart rate may drop to less than 110 beats per minute (bpm).

What causes AFE?
It is mostly agreed that this condition results from amniotic fluid entering the uterine veins and in order for this to occur there are three prerequisites:

• Ruptured membranes (a term used to define the rupture of the amniotic sac)
• Ruptured uterine or cervical veins
• A pressure gradient from uterus to vein

Although exposure to foetal tissue is common and thus finding foetal tissue within the maternal circulation is not significant, in a small percentage of women this exposure leads to a complex chain of events resulting in collapse and death.

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