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Abstract
The diagnosis of Amniotic Fluid Embolus (AFE) is often missed clinically leading to
the incorrect attribution of a major post-partum haemorrhage, which may accompany
AFE, to uterine atony. This paper reviews the research on AFE with particular emphasis
on the clinical presentation and diagnosis; both before and after death. It begins
by dealing with the difficulty of defining AFE due to confusion about the underlying
pathophysiological events. As this paper will demonstrate, the theory that AFE is
an embolic event is no longer valid. A description of the clinical manifestations
is provided so that these can be explained by the contemporary theory of AFE as an
‘anaphylactoid’ reaction. Finally, the difficulties of diagnosis, particularly laboratory
diagnosis, will be discussed. The research indicates that it is not possible to accurately
diagnose AFE, either, pre or post mortem, by any currently available laboratory tests.
Because of better diagnosis it is now known that AFE in not uncommon and, if it is
diagnosed early, a much higher rate of intact survival can be achieved than was previously
thought possible.
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© 2001 Australian College of Midwives. Published by Elsevier Inc.