Amniotic Fluid Emboli

This is an uncommon but highly lethal complication of pregnancy, first described by Steiner and Lushbough.16 While early studies reported an 86% mortality, more recent work indicates that the mortality has decreased to

Emboli The Brain
Figure 19.3 Petechial hemorrhages of brain caused by fat embolism in 21-year-old female with fracture of right femur.

61%.16,17 Unfortunately, the increased survival was accompanied by a 24% incidence of permanent neurological injury. Thus, only 15% of patients survived neurologically intact. There are no demographic factors predisposing to amniotic fluid embolism as well as no relationship to route of delivery, prolonged hard labor, or use of oxytocin.

Most cases of amniotic emboli occur during active labor, though cases have occurred as late as 90 min postpartum.1618 Clark et al. reviewed 46 cases of amniotic fluid emboli.17 Thirty women had amniotic fluid emboli during labor but before delivery, and 13 after delivery. Of these 13 cases, five had emboli following vaginal delivery, and eight during cesarean section but after delivery. Three of the patients who had cesarean sections were in labor prior to the section. Of the 13 individuals developing symptoms of amniotic fluid emboli after delivery, nine (69%) did so within 5 min of delivery.

Three of the cases reported by Clark et al. involved individuals undergoing second-trimester abortions. Ammotic fluid emboli have been reported in first- and second-trimester abortions as well as following abdominal trauma and amniocentesis.19-21

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