Amniotic Fluid Embolism (AFE) — Recognition & Management

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Sudden cardiopulmonary collapse
   Sudden cardiopulmonary collapse during labor/immediately postpartum (triad of hypoxia + hypotension + coagulopathy)? (Amniotic fluid embolism = a clinical diagnosis (no confirmatory test), triad: sudden hypoxia, hypotension, coagulopathy/DIC, occurring during labor or immediately postpartum (± seizure, cardiac arrest). A diagnosis of exclusion; finding fetal squamous cells in maternal blood is not diagnostic.)
   • Meets it (sudden collapse) → High-quality supportive resuscitation
   • Does not meet it → Does not meet it
2. [End] Does not meet it
   Evaluate other causes of sudden collapse (pulmonary embolism, hemorrhagic shock, anaphylaxis, cardiogenic, eclampsia, anesthesia-related, etc.) and manage along the appropriate pathway.
3. [End] High-quality supportive resuscitation
   1) Cardiac arrest → immediate BLS/ACLS + left uterine displacement; if undelivered and resuscitation is failing, perform a perimortem cesarean within 4–5 min to aid resuscitation and save the fetus. 2) Airway/ventilation (intubation, 100% oxygen), circulatory support (cautious fluids, vasopressors/inotropes, manage right heart failure and pulmonary hypertension). 3) Aggressively correct DIC: early coagulation testing, activate the massive transfusion protocol (RBC/plasma/platelets/cryoprecipitate/fibrinogen) + tranexamic acid. 4) Multidisciplinary (obstetrics, anesthesia, critical care, hematology), ICU, ECMO if needed.

Source guidelines & references

• SMFM Clinical Guideline No. 9: Amniotic fluid embolism diagnosis and management. Am J Obstet Gynecol 2016

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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