Synopsis
Recognise a possible amniotic-fluid embolism, resuscitate cardiorespiratory collapse and early coagulopathy, and investigate competing diagnoses without delaying support.
- AFE is a clinical diagnosis after considering other explanations for acute peripartum collapse.
- There is no reliable single blood test that confirms or excludes the diagnosis in a living patient.
- Respiratory and circulatory failure may precede obvious obstetric bleeding.
- Treat the physiological problems immediately while the diagnostic assessment continues.
- Use bedside echocardiography to guide shock management when skilled expertise is available.
- Activate major haemorrhage support early for bleeding and severe coagulopathy.
- Maternal arrest requires current pregnancy adaptations and early preparation for resuscitative hysterotomy when indicated.
Key red flags
Sudden dyspnoea, cyanosis, hypotension or cardiac arrest during labour or soon after birth is a resuscitation emergency.
Diffuse bleeding from puncture sites with rapidly falling fibrinogen can signal severe early disseminated intravascular coagulation.
Acute fetal compromise may be the first observed consequence of a maternal cardiovascular event before delivery.
Investigation priorities
Quantify impaired oxygen delivery and guide physiological correction.
Management branches
Peripartum hypoxia and hypotension or collapse develop abruptly.
- Call the emergency team with obstetric, anaesthetic, critical-care, neonatal and transfusion expertise; allocate separate airway, circulation and haemorrhage tasks.
- Provide high-concentration oxygen and effective ventilation, securing the airway through an appropriately skilled clinician when needed.
- Establish intravenous access, send urgent samples and support circulation; use blood components for haemorrhage and cautious, reassessed fluid for other hypovolaemia.
- If cardiac arrest occurs, start standard ALS immediately with uterine displacement in advanced pregnancy and early preparation for indicated resuscitative birth.
Key medicines
Tranexamic acid for associated postpartum haemorrhageGive 1 g intravenously over 10 minutes as early as possible and within 3 hours of birth; repeat 1 g if bleeding persists after 30 minutes or restarts within 24 hours of completing the first dose.It is not an AFE-specific antidote and must accompany source control and replacement of clotting deficits. Use only the intravenous route, assess thrombotic contraindications and renal impairment, and prevent confusion with neuraxial medicines.
Vasoactive support for non-arrest shockThe critical-care or anaesthetic team selects and titrates an intravenous infusion according to blood pressure, ventricular function, perfusion and the agent's concentration.There is no single fixed AFE infusion dose. Continuous monitoring is required; distinguish titrated support in a woman with a pulse from the standard bolus regimen used during cardiac arrest.