Nonfatal amniotic fluid embolism. Three possible cases and a new clinical definition.

Three obstetrical patients who experienced cardiovascular collapse followed by disseminated intravascular coagulation were cared for by the author during residency training and 5 years of private practice. All patients survived. Their clinical courses were strongly reminiscent of those of patients described in the medical literature who ultimately died with the diagnosis of "amniotic fluid embolism." Paradoxically, the mere fact of survival is generally regarded as proof that a given individual did not have an amniotic fluid embolism. Proposed herein is a new clinical definition of amniotic fluid embolism syndrome that could apply to patients who survive as well as to those who die. With this definition in mind, the prevalence and prognosis of amniotic fluid embolism syndrome is reexamined. Finally, the traditional assumption that this syndrome is a result of amniotic fluid leakage into the maternal circulation is challenged. A new source is suggested and some new thoughts regarding treatment are provided.