ABSTRACT
Amniotic fluid embolism (AFE) is a leading cause of mortality during labour and the first few postpartum hours. It is an unpredictable, probably unpreventable and often rapidly progressive obstetric emergency in which amniotic fluid, fetal cells, hair or other debris enter the maternal circulation, triggering a syndrome that includes the following: hypoxia; hypotension; unconsciousness; cardiac arrest; and coagulopathy. In the UK, maternal deaths due to AFE reported over the last six Confidential Enquiries into Maternal Deaths reports have been just under 8% of the total number of direct deaths. In an analysis of 46 cases of AFE from the US national registry, only 15% survived neurologically intact. The number of studies that have been designed in an attempt to develop an adequate animal model of AFE is testimony to the difficulties. In approaching AFE as an anaphylactic reaction, a number of reports have described increased levels of serum tryptase.
