AFE is a complication of pregnancy that occurs during delivery. It can cause failure of multiple organ systems and is typically life threatening without prompt medical treatment.
Amniotic fluid embolism (AFE), also known as anaphylactoid syndrome of pregnancy, is a pregnancy complication that causes life threatening conditions, such as heart failure.
It can affect you, your baby, or both of you. It happens when amniotic fluid (the fluid surrounding your unborn child) or fetal cells, hair, or other debris make their way into your blood.
AFE is rare. Though estimates vary, the AFE Foundation reports the condition occurs in only 1 out of every 40,000 deliveries in North America (and 1 in every 53,800 deliveries in Europe). However, it’s a leading cause of death during labor or shortly after birth.
AFE can occur during labor or shortly after giving birth in both vaginal and cesarean births. In rare cases, it can happen during an abortion or while having a small sample of amniotic fluid taken for examination (amniocentesis).
AFE is a negative reaction that occurs when amniotic fluid enters your circulatory system. It can’t be prevented, and the reason why this reaction occurs is unknown.
While the cause of AFE is unknown, research has identified some risk factors associated with the condition. These include:
- age over 35 years
- carrying multiple fetuses
- multiparty
- high blood pressure before pregnancy
- chorioamnionitis (placental infection)
- fetal growth restriction
- placenta previa
- placenta accreta
- preeclampsia
- placental abruption
- polyhydramnios
- amniocentesis
- C-section
- instrumental vaginal delivery with forceps or suction cup
- in-vitro fertilization (IVF)
Having certain conditions can also increase the risk of AFE:
- gestational diabetes
- cardiac disease
- cerebrovascular disorders
- renal disease
- asthma
The first stage of AFE usually causes cardiac arrest and rapid respiratory failure. Cardiac arrest occurs when your heart stops working, and you lose consciousness and stop breathing.
Rapid respiratory failure occurs when your lungs can’t supply enough oxygen to your blood or remove enough carbon dioxide from it. This makes it very difficult to breathe.
Other possible symptoms include:
People who survive these events may enter a second stage called the hemorrhagic phase. This occurs when there’s excessive bleeding either where the placenta was attached or, in the case of a cesarean birth, at the cesarean incision.
AFE can be fatal, especially during the first stage. Most AFE deaths occur due to the following:
- sudden cardiac arrest
- excessive blood loss
- acute respiratory distress
- multiple organ failure
According to the AFE Foundation, in roughly 50% of cases, death occurs 1 hour after symptoms start.
Diagnosis for AFE usually relies on the medical professionals’ clinical judgement in the moment, as there’s
Treatment involves managing symptoms and preventing AFE from leading to coma or death.
Oxygen therapy or a ventilator can help you breathe. Making sure that you’re getting enough oxygen is crucial so that your baby also has enough oxygen.
Your healthcare professional might request that a pulmonary artery catheter be inserted so that they can monitor your heart. Medications might also be used to manage your blood pressure.
In many cases, several blood, platelet, and plasma transfusions are necessary to replace the blood lost during the hemorrhagic phase.
Your healthcare professional will monitor your baby and watch for signs of distress. Your baby will most likely be delivered as soon as your condition is stabilized. This increases their chances of survival. In most cases, babies are transferred to the intensive care unit for close observation.
AFE can’t be prevented, and it’s challenging for healthcare professionals to predict if and when it will occur. If you’ve had AFE and are planning to have another baby, it’s recommended that you talk with a high risk obstetrician first.
They will discuss the risks of pregnancy beforehand and monitor you closely if you become pregnant again.
Per the AFE Foundation, estimated rates of mortality for people with AFE are varied. Older reports estimate that up to 80% of people don’t survive, although more recent data estimates that this number is about 40%.
People who survive AFE can often have long-term complications, which can include:
- memory loss
- organ failure
- heart damage that can be short-term or permanent
- nervous system problems
- a partial or complete hysterectomy
- damage to the pituitary gland
Mental and emotional challenges can also occur, especially if the baby doesn’t survive. Health conditions may include postpartum depression and post-traumatic stress disorder (PTSD).
According to the AFE Foundation, estimated death rates for infants with AFE are also varied.
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Some infants who survive can have long-term or lifelong complications from AFE, which may include:
- nervous system impairment that can be mild or severe
- not enough oxygen to the brain
- cerebral palsy, which is a disorder that affects the brain and nervous system
AFE is a life threatening condition that requires immediate medical attention and prompt intervention to prevent death.
Some risk factors have been identified, but it’s a very rare condition, and experts can’t say with certainty what causes it.
Prompt responses from the healthcare team can ensure someone with AFE gets the best possible outcome.