Amniotic fluid embolism: still a diagnostic enigma for obstetrician and pathologist?

Eight fatal cases of amniotic fluid embolism (AFE) are described to identify definable and preventable risk factors increasing the incidence of AFE. Maternal age, past medical history, previous pregnancies and outcome, prenatal care, gestational age, neonatal outcome, mode of delivery, time of the onset of clinical symptoms, and maternal autopsy findings were retrospectively analyzed. Risk factors and clinical manifestations present in the patients were investigated. Peripartum clinical information included tachycardia and shock as the most frequent symptoms (62.5%), while bradycardia and coma were present in 37.5% of the victims. The interval between onset of labor and symptoms ranged between 0.4 and 7.5 hours. All the women died within seven hours of the onset of the symptoms. AFE can neither be predicted nor prevented as cases occur sporadically with a broad spectrum of clinical manifestations that are less consistent than that previously reported.