Epidemiological and clinical data of amniotic fluid embolism in forensic settings

Amniotic fluid embolism (AFE) is a serious obstetric emergency, burdened with a high rate of mortality and morbidity and possible permanent neurological sequelae for those women who survive. The clinical presentation commonly includes: acute hypotension or cardiac arrest, acute hypoxia (dyspnea, cyanosis or respiratory arrest) and coagulopathy (intravascular coagulation or severe haemorrhage), which usually occur during labour, caesarean section or within 30 minutes of delivery. Some cases for the rapidity of clinical presentation, which can result in fatal outcome, run the risk of not being recognized, therefore a proper post mortem examination and histological investigation is fundamental in case of maternal death in order to make the diagnosis and should not be underestimated the incidence of this serious pathological condition. In this paper, firstly the Authors investigated the fatality rates in AFE patients and its incidence in pregnancy related deaths, extrapolating epidemiological data regarding the role of this pathology among the leading causes of maternal mortality. Secondly the contribution of autopsy has been evaluated and further investigation performed on post mortem in order to confirm or make the diagnosis of AFE to better understand this clinical entity that still remains unclear under numerous aspects.