Evidence-Based Management of Amniotic Fluid Embolism: A Systematic Review and Meta-Analysis of Clinical Interventions

To evaluate the effectiveness of therapeutic interventions for amniotic fluid embolism (AFE) through a systematic review and meta-analysis, focusing on survival outcomes.

PubMed, Embase, and the Cochrane Library were searched until June 2025 for eligible studies that evaluated therapeutic interventions for AFE. The quality of the evidence was assessed using the GRADE approach. A subgroup analysis was conducted to review all potentially effective interventions reported in case reports and case series.

Two case-control studies comprising 272 patients with AFE met the inclusion criteria of this review. Platelet transfusion (adjusted Odds Ratio [OR] 0.23, 95% Confidence Interval [CI] 0.10-0.52) and fibrinogen administration (adjusted OR 0.44, 95% CI 0.21-0.92) were significantly more common among survivors, whereas hysterectomy, uterine artery embolization, red blood cell transfusion, fresh frozen plasma administration, Factor VIIa, and tranexamic acid showed no significant association with survival. The subgroup analysis identified interventions targeting circulatory support, inflammation control, coagulation management, and bleeding control.

This systematic review suggests that platelet transfusion and fibrinogen administration may improve the survival of patients with AFE. Further research is required to develop individualized treatment strategies for this rare but potentially fatal obstetric emergency.