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OBSTETRIC ANESTHESIOLOGY

Amniotic Fluid Embolism

Richard S. Gist, MD^*, Irene P. Stafford, MD, Andrew B. Leibowitz, MD^*, and Yaakov Beilin, MD^*

From the *Department of Anesthesiology, Mount Sinai School of Medicine of New York University, New York City, New York; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Obstetrics and Gynecology, Mount Sinai School of Medicine of New York University, New York City, New York.

Address correspondence and reprint requests to Yaakov Beilin, MD, Department of Anesthesiology, The Mount Sinai Medical Center, Box 1010, One Gustave L. Levy Place, New York City, NY 10029-6574. Address e-mail toyaakov.beilin{at}mountsinai.org.

Abstract

Amniotic fluid embolism is one of the most catastrophic complications of pregnancy. First described in 1941, the condition is exceedingly rare and the exact pathophysiology is still unknown. The etiology was thought to be embolic in nature, but more recent evidence suggests an immunologic basis. Common presenting symptoms include dyspnea, nonreassuring fetal status, hypotension, seizures, and disseminated intravascular coagulation. Early recognition of amniotic fluid embolism is critical to a successful outcome. However, despite intensive resuscitation, outcomes are frequently poor for both infant and mother. Recently, aggressive and successful management of amniotic fluid embolism with recombinant factor VIIa and a ventricular assist device, inhaled nitric oxide, cardiopulmonary bypass and intraaortic balloon pump with extracorporeal membrane oxygenation have been reported and should be considered in select cases.