7 Amniotic Fluid Embolism Symptoms

Originally published 04/03/2022. Updated for accuracy and relevancy on 10/06/2023.

Knowing how to spot amniotic fluid embolism (AFE) signs and symptoms can help keep you and your baby safe. Read on to learn more.

By OBGYN and fertility expert Dr. Kenosha Gleaton

Have you heard of AFE? AFE, which is the acronym for amniotic fluid embolism, is a rare but serious pregnancy complication that can be very dangerous for you and your baby. While it is rare, you may want to know what signs and symptoms to look out for as well as inform yourself about the ways to lower the risk of AFE. 

What Is Amniotic Fluid?

Amniotic fluid refers to the liquid surrounding a fetus during pregnancy. There are many functions of amniotic fluid, including protection from maternal abdominal trauma and compression. [1] Amniotic fluid also has antibacterial properties and acts as a reservoir of fluid and nutrients for the fetus. [1] Without it, normal development and growth of fetal organs would be impossible due to the fluid and space it allows inside of the womb. Lastly, amniotic fluid is used as a tool for doctors when monitoring pregnancy progression and potential fetal outcomes. [1] 

What Is An Amniotic Fluid Embolism?

An AFE, or amniotic fluid embolism, is a severe pregnancy complication that occurs when amniotic fluid or fetal cells and debris enter the mother’s bloodstream. An AFE is most likely to occur during labor, soon after delivery, or during second-trimester procedures to abort a fetus or remove tissue following a miscarriage. [2] When AFE occurs, the body undergoes what is similar to an anaphylactic reaction, which may lead to organ dysfunction, cardiovascular collapse, coagulopathy (blood not clotting), and death. [2] While we do know that AFE is a rare event, we don’t know exactly how rare. It’s estimated that AFE occurs between 1 in 8,000 and 1 in 80,000 deliveries, with a maternal fatality rate of approximately 13-26%, and fetal fatality rate of around 10%, relative to when AFE occurs during pregnancy or delivery. [2] Learn about other complications, such as HELLP Syndrome and Preterm Labor. 

What Causes Amniotic Fluid Embolism? 

Unfortunately, the cause of an amniotic fluid embolism is still unknown. Considered an unpredictable and unpreventable event, AFE may occur in healthy women anytime during the second trimester of pregnancy up to 48 hours after delivery. [2] 

Due to the anaphylactic type reaction, many hypothesize that AFE is a result of the mother having an allergic reaction to the amniotic fluid or other fetal material. [3] Others believe a physical block to the pulmonary circulation is what causes AFE. [2] What we do know from autopsy findings is that in 70% of cases, there is evidence of pulmonary edema, and there is amniotic fluid present, which is essential for diagnosis. [2] 

Potential triggers include abortion, trauma to the abdomen, and procedures such as intrauterine injections and amnioinfusion. [2] 

Common Risk Factors

With so many unknowns regarding AFE incidence and cause, the following risk factors are identified from various case studies [2]: 

• Maternal age of 35 years or older
• C-section delivery
• Multiparity (multiple pregnancies)
• Eclampsia
• Fetal death
• Fetal distress
• Forceps-assisted and vacuum-assisted vaginal deliveries
• Abdominal trauma
• Placenta previa

Amniotic Fluid Embolism Symptoms

If you’re concerned you may fit into one or more risk factors, talk to your doctor about your concerns and educate yourself on potential signs of AFE. Presenting symptoms may involve multiple organ systems, and your doctor may use some basic lung scans and serum levels to determine diagnosis. [2] 

What Does An Amniotic Fluid Embolism Feel Like?

Other signs and symptoms that may be indicative of AFE are typically sudden and may include [2]:

• Sudden chills, shivering, sweating, vomiting, or coughing
• Labored breathing
• Fetal bradycardia
• Hypotension
• Altered mental state
• Rapid decline of blood oxygen levels 
• Sudden skin discoloration 

Diagnosing AFE

In order to actually diagnose someone with AFE, four criteria must be met [2]:

1. Acute hypotension or cardiac arrest: Low blood pressure or loss of heartbeat
2. Actue hypoxia: Drop in oxygen levels 
3. Coagulopathy or severe hemorrhage: Blood is not clotting properly
4. The above three criteria are occuring during labor, delivery, abortion, or soon after postpartum.

AFE Maternal Effects

As we’ve already discussed, AFE is a very serious condition that may result in serious organ damage, cardiovascular trauma, or death. Data from 2006-2016 reported that AFE accounted for 5-15% of maternal deaths in developed countries. [4] While few women are able to recover after an AFE with no permanent damage, it’s common that survivors have neurologic deficits due to the lack of oxygen flow to the brain. Other long term effects may include heart damage, nervous system dysfunction, and hysterectomy. [5] 

AFE Fetal Effects

The survival rate for a fetus is about 70% and long term effects are closely tied to the time lapsed between maternal cardiac arrest and delivery of the baby. [2] AFE has the potential to prolong delivery, causing fetal distress. Fetal distress increases the risk of complications leading to potential brain damage or conditions such as cerebral palsy. [5] There is also the potential of infant death if delivery takes too long, or if the baby is deprived of oxygen. 

Treatment for Amniotic Fluid Embolism

Unfortunately the survival rate for mothers experiencing AFE is still relatively low, but recognizing the condition early and acting quickly to resuscitate and deliver the fetus are necessary for a successful outcome. While most treatments of AFE are supportive, some new and uncommon treatments have shown successful outcomes especially when used as early as possible.

These novel approaches include ECMO, extracorporeal membrane oxygenation, which is often referred to as life support, and can take on the work of the heart and lungs for a while until the organs begin working again. [6] Other options may include an exchange transfusion, in which blood or plasma is exchanged for fresh donor blood. [2] Other approaches that have shown some success all relate back to supporting the heart or cardiovascular system through surgery or other intensive procedures. 

How to Prevent Amniotic Fluid Embolism 

Of course this is all very unsettling to think about, but remember that AFE is a rare complication, and doctors are aware of the risks and know what symptoms to look out for during labor and delivery. There are some ways to prevent excessive risk of AFE, such as protecting the uterus and abdomen from any trauma during procedures or maneuvers. [2] Cutting or injuring the placenta during c-section deliveries should also be avoided when possible. Where possible, excessively strong or frequent labor contractions should be controlled using medication or other coping mechanisms. If you have any concerns about AFE, talk with your OBGYN.

Supporting a Healthy Pregnancy

Pregnancy comes with much excitement, as well as many challenges, fears, and questions. It can be easy to let the worst possible outcome play out in our heads, but remember that complications such as AFE are typically very rare and unfortunately, hard to predict. 

What you can control is what you put into your body and how you take care of it! Try Natalist Prenatal Daily Packets or the TLC Trio for a little self-care, and focus on maintaining your overall health and wellness. You should talk to your doctor about any concerns you may have, and check out the Natalist blog for more information on nutrition, pregnancy, and more. 

References:

1. Fitzsimmons ED, Bajaj T. Embryology, Amniotic Fluid. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541089/#
2. Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S. Amniotic fluid embolism. J Anaesthesiol Clin Pharmacol. 2016;32(2):153-159. doi:10.4103/0970-9185.173356
3. Stafford, I. National Organization for Rare Disorders. Accessed October 2023. https://rarediseases.org/rare-diseases/amniotic-fluid-embolism/
4. Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evidence-based review [published correction appears in Am J Obstet Gynecol. 2010 Jan;202(1):92]. Am J Obstet Gynecol. 2009;201(5):445.e1-445.13. doi:10.1016/j.ajog.2009.04.052
5. Amniotic Fluid Embolism. Birth Injury Help Center. Accessed October 2023. https://www.birthinjuryhelpcenter.org/amniotic-fluid-embolism.html
6. Wu Y, Luo J, Chen T, et al. Successful ECMO-assisted open chest cardiopulmonary resuscitation in a postpartum patient with delayed amniotic fluid embolism. Eur J Med Res. 2022;27(1):19. Published 2022 Feb 3. doi:10.1186/s40001-021-00628-1