The amniotic fluid embolism syndrome: 10 years' experience at a major teaching hospital

A review of the syndrome of amniotic fluid embolism (AFE) was carried out over a 10 year period, 1984-1993, at the Royal Women's Hospital, Brisbane. There were 9 patients with AFE, of whom 2 died--this gave an incidence of fatal AFE of 3.37 per 100,000 pregnancies at the hospital, in comparison with an incidence of 1.03 per 100,000 pregnancies over a 27-year period in Australia. The study revealed no identifiable risk factors in the characteristics of the patient or her baby, labour and delivery. Three of the patients did not undergo labour and in 4 of the 6 who did, the duration was less than 12 hours. The AFE syndrome could present before, during or after delivery; the common features were shock and respiratory distress, with coagulopathy occurring in 5 patients. Current views of predisposing factors, pathogenesis, diagnosis and management are discussed.