Amniotic fluid embolus


  • Maternal mortality rate ~80%
  • 85% of survivors have neurologic sequelae
  • Occurs in 2-8 per 100,000 deliveries[1]
    • Responsible for ~10% of maternal mortality in US

Risk Factors

  • Cesarean delivery
  • Advanced maternal age
  • Abnormal placental implantation
  • Uterine rupture
  • Eclampsia
  • Amniocentesis
  • Trauma

Clinical Features

Differential Diagnosis

3rd Trimester/Postpartum Emergencies


Post cesarean chest X-ray in a patient with acute amniotic fluid embolus.
Chest X-ray with diffuse infiltration throughout the lungs in a patient with acute amniotic fluid embolus.
Chest CT showing homogeneous ground-glass opacities in a patient with acute amniotic fluid embolus.
  • Diagnosis of exclusion
  • Consider CXR and/or chest CT


  • Treat hypoxia (may require intubation)
  • Treat hypotension → Pressors / blood products
  • Avoid hypoperfusion → Place patient in left lateral decubitus position
  • Immediate delivery of fetus → Emergent c-section

A-OK Medications

Only case reports have described the following three therapies[2]

  1. Atropine - 1mg IV
    • Vagolytic properties may help
  2. Ondansetron 8 mg IV
    • Blocking of serotonin receptors can inhibits the release of more inflammatory mediators.
  3. Ketorolac - 30mg IV
    • Can block thromboxane production and prevent coagulopathies.


  • Admit

See Also


  1. Fong A, Chau CT, Pan D, et al. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med. 2014 Jun 30. 1-6.
  2. Rezai S. et al. Atypical Amniotic Fluid Embolism Managed with a NovelTherapeutic Regimen Case Reports in Obstetrics and Gynecology. 2017.