Amniotic fluid embolism as a cause of sudden maternal death.

The aetiology of amniotic fluid embolism has remained very much an enigma, although recent evidence points towards a combination of a severe haemodynamic disturbance, consisting of transient pulmonary hypertension, profound hypoxia and left ventricular failure, followed by secondary coagulopathy in about 40 per cent of patients who survive the initial event. Leucotrienes, prostaglandins and other vasoactive substances contained in amniotic fluid are postulated to play a fundamental role in its pathogenesis. In addition, amniotic fluid is also thought to possess thromboplastin-like properties. In common with all other causes of maternal death, it warrants a thorough and careful medico-legal investigation.