Rev Bras Ginecol Obstet. 2026 Aug 13;48:e-FPS11. doi: 10.61622/rbgo/2026FPS11. eCollection 2026.
ABSTRACT
•Amniotic fluid embolism is a rare condition with high maternal mortality. It typically occurs during labor or delivery, and the pathogenesis has not yet been fully elucidated. •Survival of parturients with amniotic fluid embolism requires early recognition, rapid initiation of treatment, and access to skilled care based on the management of critically ill obstetric patients. •The classic clinical presentation of amniotic fluid embolism involves sudden hypoxia and hypotension or cardiopulmonary arrest, accompanied or immediately followed by non-cardiogenic pulmonary edema and hemorrhage secondary to disseminated intravascular coagulation. •In cases of amniotic fluid embolism occurring during labor, bleeding typically originates at invasive interventions sites (intravascular lines and urinary catheterization). Following vaginal or cesarean delivery, bleeding arises primarily from the uterus, birth canal lacerations, and incision sites (abdominal wall and episiotomies). •Key laboratory abnormalities observed in amniotic fluid embolism include decreased fibrinogen levels, thrombocytopenia, and elevated D-dimer levels. The latter has limited diagnostic value, as levels are typically elevated during pregnancy and the postpartum period. •Arterial blood gas analysis in amniotic fluid embolism indicates the presence of hypoxemia and metabolic acidosis. Although chest radiography is initially unremarkable, if pulmonary edema and respiratory distress syndrome are present, dense bilateral pulmonary infiltrates may be observed. •The identification of amniotic fluid debris in pulmonary artery catheters or histopathological samples of lung tissue should not be considered diagnostic of amniotic fluid embolism. •The primary goals in managing amniotic fluid embolism are cardiopulmonary resuscitation, hemorrhage control, reversal of coagulopathy, and when indicated, fetal delivery. •In cases of amniotic fluid embolism accompanied by coagulopathy, massive transfusion is a necessary measure for effective, definitive treatment. The infusion of uterotonics, non-surgical invasive interventions (intrauterine balloons and intrauterine suction systems), and surgical procedures (vascular ligation, uterine compression sutures, and hysterectomy) may be used as adjuncts to control hemorrhage but are not considered definitive treatments. •The main differential diagnoses for amniotic fluid embolism include complications of neuraxial anesthesia; hemorrhage due to uterine atony, retained products of conception, and/or birth canal trauma; placental abruption; pulmonary thromboembolism; air embolism; acute myocardial infarction; and anaphylactic, cardiogenic, or septic shock.
PMID:42923891 | PMC:PMC13690382 | DOI:10.61622/rbgo/2026FPS11