{"id":393,"date":"2020-01-31T01:00:10","date_gmt":"2020-01-31T06:00:10","guid":{"rendered":"https:\/\/obgconnectdev.wpengine.com\/library\/?p=393"},"modified":"2024-12-22T21:34:52","modified_gmt":"2024-12-23T02:34:52","slug":"amniotic-fluid-embolism-afe","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/library\/2020\/01\/31\/amniotic-fluid-embolism-afe\/","title":{"rendered":"Amniotic Fluid Embolism (AFE)"},"content":{"rendered":"\n<ul class=\"wp-block-list\">\n<li><a href=\"#key-points\">Key Points<\/a><\/li>\n\n\n\n<li><a href=\"#background\">Background<\/a>\n<ul class=\"wp-block-list\">\n<li><a href=\"#pathophysiology\">Pathophysiology<\/a><\/li>\n\n\n\n<li><a href=\"#diagnosis-of-afe\">Diagnosis of AFE<\/a><\/li>\n\n\n\n<li><a href=\"#management\">Management<\/a><\/li>\n\n\n\n<li><a href=\"#differential-diagnosis\">Differential Diagnosis<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><a href=\"#primary-sources\">Primary Sources<\/a><\/li>\n\n\n\n<li><a href=\"#recommendations\">Professional Recommendations<\/a><\/li>\n\n\n\n<li><a href=\"#references\">References<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/obgconnect.com\/library\/2020\/03\/29\/labor-and-delivery-table-of-contents\/\"><strong>ObG L&amp;D<\/strong> Table of Contents<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"key-points\">KEY POINTS:<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Amniotic fluid embolism (AFE) is a rare cause of maternal collapse during or immediately after delivery, seen in approximately 1.9 to 6.1 per 100,000 births (Pacheco et al. AJOG, 2020)<\/li>\n\n\n\n<li>Mortality estimates for AFE range from 20% to 60% depending on the diagnostic criteria used, however when cardiac arrest occurs, survival rates are much lower (Clark. Obstet Gynecol, 2014) <\/li>\n\n\n\n<li>Diagnosis\n<ul class=\"wp-block-list\">\n<li>Classic diagnostic triad occurring in labor, at, or immediately after, delivery\n<ul class=\"wp-block-list\">\n<li>Sudden hypoxia | Hypotension | Coagulopathy <\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Right ventricular strain or failure due to pulmonary vasoconstriction may be seen\n<ul class=\"wp-block-list\">\n<li>Often evident on transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) once circulation returns (Pacheco et al. AJOG, 2020)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Management protocols based on expert opinion due to limited published data with focus on\n<ul class=\"wp-block-list\">\n<li>Team training |Simulation |Coordination<\/li>\n\n\n\n<li>Outcomes appear to be improved if obstetrician and anesthesiologist are present (Fitzpatrick et al. PLoS Medicine, 2019) &nbsp;&nbsp;<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading background\" id=\"background\">BACKGROUND:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"pathophysiology\">Pathophysiology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>\u201cMaternal shock\u201d from presumed embolism of amniotic fluid was first described in a case series in 1941, and this etiology was unchallenged for many years\n<ul class=\"wp-block-list\">\n<li>The findings in this series have since been disproved, however the name of \u201cAFE\u201d has continued in use<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>AFE is an abnormal activation of the pro-inflammatory mediator systems in response to release of fetal tissue in maternal circulation (Clark. Obstet Gynecol, 2014)\n<ul class=\"wp-block-list\">\n<li>Transient but profound systemic and pulmonary hypertension can lead to maternal cardiac arrest<\/li>\n\n\n\n<li>Arrest is often followed by DIC<\/li>\n\n\n\n<li>Cause of DIC unknown | Because DIC is also seen in cases of placental pathology (e.g., abruption and accreta), placental etiology may be an underlying mechanism&nbsp;&nbsp;&nbsp; <\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"diagnosis-of-afe\">Diagnosis of AFE<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Clark Criteria<\/h4>\n\n\n\n<p><em>Developed under the auspices of the \u201cM in Maternal-Fetal Medicine Committee\u201d of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation (Clark et al. AJOG, 2016)&nbsp;<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sudden onset of cardiorespiratory arrest, or both hypotension (systolic blood pressure &lt;90 mm Hg) and respiratory compromise (dyspnea, cyanosis, or peripheral capillary oxygen saturation [SpO2] &lt;90%)<\/li>\n\n\n\n<li>Coagulopathy must be detected prior to loss of sufficient blood to itself account for dilutional or shock-related consumptive coagulopathy<\/li>\n\n\n\n<li>Clinical onset during labor or within 30 min of delivery of placenta<\/li>\n\n\n\n<li>No fever (\u226538.0\u00b0C) during labor<\/li>\n\n\n\n<li>DIC: Based on the International Society on Thrombosis and Haemostasis (ISTH) DIC score (modified for pregnancy) | Score \u22653 using the is following scoring system is compatible with overt DIC in pregnancy\n<ul class=\"wp-block-list\">\n<li>Platelet count\n<ul class=\"wp-block-list\">\n<li>&gt;100,000\/mL = 0 <\/li>\n\n\n\n<li>&lt;100,000\/mL = 1 <\/li>\n\n\n\n<li>&lt;50,000\/mL = 2<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Prolonged PT or INR\n<ul class=\"wp-block-list\">\n<li>&lt;25% increase = 0 <\/li>\n\n\n\n<li>25-50% increase = 1 <\/li>\n\n\n\n<li>&gt;50% increase = 2 <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Fibrinogen level\n<ul class=\"wp-block-list\">\n<li>&gt;200 mg\/L = 0 <\/li>\n\n\n\n<li>&lt;200 mg\/L = 1 <\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"management\">Management<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>First response: Effective maternal CPR per ACLS protocol (see related OBG L&amp;D Maternal Cardiac Arrest chapter)<\/li>\n\n\n\n<li>Once patient is stabilized\n<ul class=\"wp-block-list\">\n<li>TTE or TEE (if appropriately trained personnel are available) to diagnose right heart strain or failure<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Management can be tailored to include\n<ul class=\"wp-block-list\">\n<li>Limits on fluid bolus<\/li>\n\n\n\n<li>Ventilator adjustments to prevent further pulmonary hypertension<\/li>\n\n\n\n<li>Medications for right heart failure<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If DIC occurs\n<ul class=\"wp-block-list\">\n<li>Initiate massive transfusion protocol (see &#8216;Related Topics&#8217; below) <\/li>\n\n\n\n<li>Higher dose (2g) vs lower dose of tranexamic acid (TXA) may improve maternal outcome (Fitzpatrick et al. PLoS Medicine, 2019) <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Role of ECMO\n<ul class=\"wp-block-list\">\n<li>There are case reports of ECMO being used as an adjunct to provide ventilatory support <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Women who experience cardiac arrest and multiorgan failure \u2013 including acute lung injury and or ischemic brain injury \u2013 often have a longer, more complex recovery&nbsp; <\/li>\n\n\n\n<li>Acute management protocols are based on expert opinion and case reports\n<ul class=\"wp-block-list\">\n<li>See primary sources below for two regimens<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"differential-diagnosis\">Differential Diagnosis<\/h3>\n\n\n\n<p><em>SMFM notes that while the following may be included in the differential diagnosis depending on signs and symptoms, \u201cBedside echocardiography demonstrating right ventricular dysfunction favors the diagnosis of amniotic fluid embolism\u201d <\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cardiac: Myocardial infarction | Cardiogenic<br>shock | Peripartum Cardiomyopathy\n<ul class=\"wp-block-list\">\n<li>Look for risk factors such as diabetes, smoking,<br>obesity, dyslipidemia, history of CAD<\/li>\n\n\n\n<li>Cardiac troponins and 12 lead ECG can help with<br>diagnosis <\/li>\n\n\n\n<li>Echocardiogram to assess patient for dilated<br>cardiomyopathy <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Pulmonary embolism\n<ul class=\"wp-block-list\">\n<li>CT angiography or ventilation perfusion scan <\/li>\n\n\n\n<li>Thromboembolism not generally associated with<br>DIC <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Anesthesia complication\n<ul class=\"wp-block-list\">\n<li>High spinal: Apnea but not usually associated<br>with cardiovascular collapse&nbsp; <\/li>\n\n\n\n<li>Intravascular injections of local anesthetic:<br>Timing of collapse usually related temporally to injection<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Air embolism\n<ul class=\"wp-block-list\">\n<li>Venous or atrial (latter associated with<br>neurologic findings) <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Eclampsia\n<ul class=\"wp-block-list\">\n<li>Association with seizures <\/li>\n\n\n\n<li>DIC and cardiovascular collapse not commonly<br>seen <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Anaphylactic shock\n<ul class=\"wp-block-list\">\n<li>Symptoms include urticarial rash and<br>bronchospasm (bronchospasm may infrequently occur in AFE)&nbsp;&nbsp; <\/li>\n\n\n\n<li>Temporally related to medication administration<\/li>\n\n\n\n<li>Right heart failure and DIC are usually not<br>associated with anaphylaxis <\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"primary-sources\">PRIMARY SOURCES:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"pacheco-et-al\">Pacheco et al. AJOG, 2020<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In this clinical expert article, the authors review etiology of AFE and propose a treatment pathway | They acknowledge that there are no studies of treatment regimens<\/li>\n\n\n\n<li>The following proposed treatment plan is based on their critical care expertise\n<ul class=\"wp-block-list\">\n<li>Start high quality CPR<\/li>\n\n\n\n<li>Defibrillate as needed<\/li>\n\n\n\n<li>Prepare for operative delivery or early perimortem delivery<\/li>\n\n\n\n<li>Early TTE after return of circulation | Do not interrupt compressions for TTE<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Evidence of right heart strain (Cor Pulmonale)\n<ul class=\"wp-block-list\">\n<li>Vasopressors<\/li>\n\n\n\n<li>Inotropes <\/li>\n\n\n\n<li>Pulmonary vasodilators<\/li>\n\n\n\n<li>Avoid fluid bolus<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Evidence of DIC\n<ul class=\"wp-block-list\">\n<li>Activate massive transfusion protocol | Transfuse at 1:1:1 PRBCs\/FFP\/Plt<\/li>\n\n\n\n<li>Uterotonics as needed to control bleeding<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>If persistent hemodynamic instability: Consider ECMO<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"rezai-et-al\">Rezai et al. Case Reports in Obstetrics and Gynecology, 2017<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Case report of AFE managed with a novel regimen,<br>entitled \u2018A-OK\u2019 | Paper includes literature review of previous use of this<br>protocol <\/li>\n\n\n\n<li>In their case report, instituting this protocol<br>at the time of maternal collapse resulted in recovery of blood pressure and<br>oxygenation within 2 to 3 minutes&nbsp; <\/li>\n\n\n\n<li>The protocol is meant to address the underlying<br>pathophysiology of the collapse\n<ul class=\"wp-block-list\">\n<li><strong>A<\/strong>tropine<br>(0.2mg): Counteracts vagal overstimulation | Improves vasomotor tone <\/li>\n\n\n\n<li><strong>O<\/strong>ndansetron<br>(8mg): Blocks serotonin receptors inhibiting release of further mediators <\/li>\n\n\n\n<li><strong>K<\/strong>etorolac<br>(15mg): Blocks thromboxane production preventing coagulopathy<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>This protocol is not widely<br>incorporated into expert opinion at this time<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"recommendations\">PROFESSIONAL RECOMMENDATIONS:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">SMFM<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Open access document provides an outline of<br>diagnosis and management for AFE, including medication selection and dosing for<br>management of right heart failure <\/li>\n\n\n\n<li>Key recommendations for post-arrest management<br>include\n<ul class=\"wp-block-list\">\n<li>Use of fluids, vasopressors, and inotropes | Goal<br>is to maintain a mean arterial blood pressure of 65 mmHg<\/li>\n\n\n\n<li>Treat fever aggressively: Fever may worsen<br>ischemia-reperfusion injury to the brain <\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Avoid administration of 100% oxygen after<br>survival of cardiac arrest | Hyperoxia will also worsen ischemia-reperfusion<br>injury, and <\/li>\n\n\n\n<li>Wean inspired oxygen fraction to maintain a<br>pulse oxymetry value of 94% to 98%<\/li>\n\n\n\n<li>Maintain serum glucose levels between 140 to 180<br>mg\/dL | Use IV insulin infusions as needed<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\" \/>\n\n\n\n<h2 class=\"wp-block-heading\">Want to see the rest of the L&amp;D eBook?<\/h2>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link has-very-light-gray-color has-text-color has-background wp-element-button\" href=\"https:\/\/obgconnect.com\/library\/shop\/\" style=\"background-color:#b1a751\" rel=\"https:\/\/obgconnect.com\/library\/labor-and-delivery\/\">&#8212;                    <strong>Try it Free!           <\/strong>         &#8212;<\/a><\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\" \/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"references\">REFERENCES:<\/h2>\n\n\n\n<p><a aria-label=\"Clinical Expert Series: Amniotic Fluid Emoblism (Clark. Obstet Gynecol, 2014)  (opens in a new tab)\" href=\"https:\/\/journals.lww.com\/greenjournal\/Abstract\/2014\/02000\/Amniotic_Fluid_Embolism.16.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Clinical Expert Series: Amniotic Fluid Emoblism (Clark. Obstet Gynecol, 2014)<\/a><\/p>\n\n\n\n<p><a aria-label=\"Amniotic fluid embolism: principles of early clinical management (Pacheco et al. AJOG, 2020) (opens in a new tab)\" href=\"https:\/\/www.ajog.org\/article\/S0002-9378(19)30943-3\/abstract\" target=\"_blank\" rel=\"noreferrer noopener\">Amniotic fluid embolism: principles of early clinical management (Pacheco et al. AJOG, 2020)<\/a><\/p>\n\n\n\n<p><a aria-label=\"Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen (Rezai et al. Case Reports in Obstetrics and Gynecology, 2017)  (opens in a new tab)\" href=\"https:\/\/www.hindawi.com\/journals\/criog\/2017\/8458375\/\" target=\"_blank\" rel=\"noreferrer noopener\">Atypical Amniotic Fluid Embolism Managed with a Novel Therapeutic Regimen (Rezai et al. Case Reports in Obstetrics and Gynecology, 2017) <\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.smfm.org\/publications#\/581\" target=\"_blank\" rel=\"noreferrer noopener\">SMFM: Amniotic Fluid Embolism: Diagnosis and Management <\/a><\/p>\n\n\n\n<p><a aria-label=\"Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study (Fitzpatrick et al. PLoS Medicine, 2019)  (opens in a new tab)\" href=\"https:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1002962\" target=\"_blank\" rel=\"noreferrer noopener\">Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study (Fitzpatrick et al. PLoS Medicine, 2019) <\/a><\/p>\n\n\n\n<p><a aria-label=\"Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies (Clark et al. AJOG, 2016)  (opens in a new tab)\" href=\"https:\/\/www.ajog.org\/article\/S0002-9378(16)30382-9\/fulltext\" target=\"_blank\" rel=\"noreferrer noopener\">Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies (Clark et al. AJOG, 2016) <\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/exxcellence.org\/list-of-pearls\/amniotic-fluid-embolism\/\" target=\"_blank\" rel=\"noreferrer noopener\">SASGOG Pearls of Exxcellence | The Society for Academic Specialists in General Obstetrics &amp; Gynecology<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Amniotic fluid embolism (AFE) is a rare cause of maternal collapse during or immediately after delivery, seen in approximately 1.9 to 6.1 per 100,000 births (Pacheco et al. AJOG, 2020)<\/p>\n","protected":false},"author":3,"featured_media":902,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[11],"tags":[34,35,36],"class_list":["post-393","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-labor-and-delivery","tag-maternal-code","tag-pph","tag-transfusion"],"acf":[],"featured_image_urls_v2":{"full":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured-150x150.jpg",150,150,true],"medium":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured-300x199.jpg",300,199,true],"medium_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"1536x1536":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"2048x2048":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"ultp_layout_landscape_large":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"ultp_layout_landscape":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"ultp_layout_portrait":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"ultp_layout_square":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"woocommerce_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",300,199,false],"woocommerce_single":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured.jpg",400,265,false],"woocommerce_gallery_thumbnail":["https:\/\/obgconnect.com\/library\/wp-content\/uploads\/sites\/3\/2020\/04\/alex-pasarelu-S8BW-Wx9G8I-unsplash-featured-100x100.jpg",100,100,true]},"post_excerpt_stackable_v2":"<p>Amniotic fluid embolism (AFE) is a rare cause of maternal collapse during or immediately after delivery, seen in approximately 1.9 to 6.1 per 100,000 births (Pacheco et al. AJOG, 2020)<\/p>\n","category_list_v2":"<a href=\"https:\/\/obgconnect.com\/library\/category\/labor-and-delivery\/\" rel=\"category tag\">ObG L&amp;D\u2122<\/a>","author_info_v2":{"name":"Nikola Dikic","url":"https:\/\/obgconnect.com\/library\/author\/nikola\/"},"comments_num_v2":"0 comments","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Amniotic Fluid Embolism (AFE) - OBG LIBRARY<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/obgconnect.com\/library\/2020\/01\/31\/amniotic-fluid-embolism-afe\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Amniotic Fluid Embolism (AFE) - OBG LIBRARY\" \/>\n<meta property=\"og:description\" content=\"Amniotic fluid embolism (AFE) is a rare cause of maternal collapse during or immediately after delivery, seen in approximately 1.9 to 6.1 per 100,000 births (Pacheco et al. 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