Amniotic fluid embolism (AFE) is a rare but serious complication of pregnancy. It happens when fetal cells or amniotic fluid, which is the fluid surrounding a fetus in the uterus during pregnancy, enters the parent’s bloodstream.
AFE is rare, but it can be life threatening.
It usually occurs during labor or after birth, and it can affect the parent, fetus, or both. Initial symptoms may include shortness of breath, agitation, nausea, and vomiting.
The symptoms can quickly become serious, so a person should seek emergency medical care right away.
Read on to learn more about the symptoms of AFE, what causes it, risk factors, and more.
AFE, or
Research suggests that the condition affects approximately 5.1 deliveries out of 100,000 in the United States. This means that it occurs in around 0.005% of deliveries.
In the uterus, a fetus is surrounded by the amniotic sac, which is filled with fluid that provides support and protection. If amniotic fluid or cells from the fetus enter the parent’s bloodstream, it can block blood flow in an artery. This is called an embolism.
Most instances of AFE occur during or immediately after delivery. They can happen during both cesarian and vaginal deliveries.
In very rare cases, AFE can also occur during or after an abortion.
AFE usually develops suddenly. It affects multiple organ systems around the body, which makes it very dangerous. Without treatment, it can cause heart failure and cardiac arrest.
Some early signs and symptoms include:
- agitation
- increased anxiety
- chills
- confusion
- shortness of breath
- nausea or vomiting
- skin discoloration
- a sense of impending doom
- abnormal vital signs
- fetal distress
Some later symptoms include:
- seizures
- loss of consciousness
- bleeding from the cesarean incision, uterus, or intravenous sites
AFE is considered an emergency, so treatment is prompt and aggressive. Researchers note that early recognition of AFE is important to a positive outcome for both the parent and the fetus.
Initially, healthcare professionals
Treatment for the parent
- delivery of supplemental oxygen
- cardiopulmonary resuscitation, which is a technique that restarts an individual’s heartbeat, breathing, or both
- use of a ventilator, which is a mechanical device that helps a person breathe
Healthcare professionals may also administer medications to help maintain the person’s blood pressure and reduce fluid in the lungs and around the heart.
When a person is in labor, amniotic fluid or fetal cells can enter the bloodstream. In many cases, this causes no problems.
However, some people’s immune systems react badly to these cells. They treat them as a foreign substance, thereby triggering an allergic reaction. This causes overwhelming inflammation, causing an embolism and harming healthy tissues.
In most cases, the amniotic fluid and fetal cells stem from small tears in the cervix. They can also come from damage to or anomalies in the placenta, which is the organ connecting the fetus to the parent.
Certain individuals are at higher risk of experiencing AFE. According to one
- are older
- have intense contractions during labor
- have had five or more pregnancies
- have a cesarean delivery
- have induced labor
- are having multiple babies
- have tears in the cervix or uterus
Some pregnancy-related complications increase a person’s risk of AFE. These include:
- placenta previa, which is a condition wherein the placenta partially or completely blocks the cervix
- eclampsia, which is a condition involving high blood pressure that triggers convulsions, often followed by a coma
- early separation of the placenta from the wall of the uterus
- fetal distress or death
Although some factors may increase a person’s risk of AFE, there are no clear warning signs of the condition. It is currently impossible to predict, anticipate, or prevent.
Healthcare professionals know that the condition happens because of an immune response, but they do not understand why it affects some people and not others.
People giving birth in a hospital can receive immediate medical care when they experience symptoms of AFE.
However, if a person is having a home birth, has gone into labor, or has returned home after giving birth, they should be aware of the early symptoms of the condition. They should call 911 and seek emergency medical attention if they think they may be experiencing AFE.
Early treatment
AFE is a dangerous, and sometimes fatal, condition. Statistics on parental and fetal survival rates vary, but they do reveal the serious nature of the complication.
Outlook for the parent
One article from 2021 reports that the death rates of parents who experience AFE are in the range of
The outlook is better if a person receives an early diagnosis and prompt treatment. However, about two-thirds of people who survive AFE will have lung, neurological, and cardiovascular impairments.
Although researchers do not know the risk of AFE reoccurrence, there are some reports of people having healthy future pregnancies.
People who have experienced AFE and who want to get pregnant again may wish to contact a doctor.
Outlook for the fetus
The death rate for the fetuses involved in AFE is about
- cognitive disabilities, which are conditions affecting one’s ability to think
- cerebral palsy, which is a condition involving poor muscle coordination
- hypoxic-ischemic encephalopathy, which is a brain condition that happens when the brain goes too long without oxygen
AFE is a rare but serious condition. It occurs when amniotic fluid or fetal cells enter the parent’s bloodstream, causing a blockage.
There is no known way to prevent the condition, but
AFE is considered an emergency, so people with any symptoms of the condition need immediate medical attention.