Amniotic Fluid Embolism: The  Unpredictable Catastrophe Alexander Storm, Jacob Jones MD, Benjamin Ludden 

Rare (≈1 in 20,000–50,000 deliveries) but often catastrophic 

Classically presents during labor or postpartum with: 

● Sudden hypotension, hypoxia, altered mental status 

● Possible coagulopathy / DIC 

Pathophysiology: Maternal immune response to amniotic components → inflammatory and vasospastic  cascade 

**Mortality remains high without rapid recognition and resuscitation

Case: Twin Delivery Complicated by Suspected AFE 

● 30‑year‑old G‑DiDi pregnancy under  

epidural, in OR for twin delivery 

● After delivery of twin A → internal version for  

breech twin B 

● Abrupt bradycardia, hypotension, altered  

mental status → suspected AFE 

● Excluded anesthetic toxicity, PE,  

hemorrhage 

● A‑OK protocol initiated: 

○ Atropine, Ondansetron, Ketorolac 

■ Epinephrine, intubation,  

supportive care 

● Rapid emergency C‑section for twin B →  

both neonates and mother recovered 

● Extubated after 24 h in ICU, no neurologic  

sequelae

Teaching Points & Takeaways 

● Always suspect AFE with sudden hemodynamic or respiratory  collapse during labor or delivery 

● Diagnosis of exclusion: no definitive test 

● Immediate supportive resuscitation = survival: 

○ Airway control, oxygenation, vasoactive support 

○ Consider A‑OK protocol to modulate cardiovascular reflexes ● Multidisciplinary readiness—OB, anesthesia, ICU, neonatology—is  essential 

● Successful outcomes hinge on team communication and rapid  decision‑making 

Recognize fast, act faster — that’s the difference in AFE.