Clotting screen is often very abnormal, even before any observable haemorrhage, and will then exclude many other diagnoses.Symptoms occurring during delivery with high likelihood of collapse and incipient disseminated intravascular coagulation.It requires a high index of suspicion on clinical criteria, as above. ĪFE is a diagnosis of exclusion and is made clinically. These are due to a combination of mechanical blockage of blood vessels with amniotic fluid, an inflammatory reaction in the maternal circulation and an, as yet, poorly understood immunological reaction that has been compared to anaphylaxis or severe sepsis. Amniotic fluid embolises to the pulmonary circulation and the patient responds with the rapid development of a complex constellation of findings with sudden cardiovascular collapse, acute left ventricular failure with pulmonary oedema, disseminated intravascular coagulation and neurological impairment. A prospective, national study of AFE is being undertaken by the United Kingdom Obstetric Surveillance System (UKOSS) and has currently found an estimated incidence in the UK of 1.7 cases per 100,000 maternities.Analysis of UK data has shown an increased risk in older, ethnic-minority women and an association between postnatal AFE and caesarean delivery. Placenta praevia and placental abruption appear to increase the risk 3- to 10-fold. Internationally it has been found to be significantly associated with induction of labour and maternal age.11 women were reported as having died of AFE in the four years between 2009-2012. The 2014 triennial report from Mothers and Babies: Reducing Risk through Audit and Confidential Enquiries across the UK (MBRRACE-UK) into maternal deaths in the UK and Ireland, showed a mortality rate of 0.33 per 100,000 pregnancies.Although rare, it is the fifth leading cause of direct maternal mortality in the UK.Entry of amniotic fluid into the maternal circulation was first described in 1926 by J R Meyer however, the first recorded maternal death from amniotic fluid embolism (AFE) was not until 1941. Amniotic fluid embolism is a rare but severe complication of pregnancy.
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