Amniotic Fluid Embolism: Clinic, Diagnosis, Treatment, Outcomes

Abstract

Study aim: To analyze clinical case and compare with the current literature available on the clinical presentation, diagnostic criteria, treatment strategies, and outcomes of the mother and newborn associated with amniotic fluid embolism (AFE). Objectives: 1. To review available literature to identify and describe the spectrum of clinical manifestations and symptoms associated with amniotic fluid embolism. 2. To assess the diagnostic approaches, criteria, and reliability of different modalities used for diagnosing amniotic fluid embolism. 3. To analyze published evidence concerning various treatment modalities utilized for managing amniotic fluid embolism. 4. To review and analyze reported patient and newborn outcomes. Research methodology and methods: This thesis includes a systematic review based on the Population, Intervention, Comparison, Outcome (PICO) methodology and a clinical case analysis of a suspected AFE. The systematic review includes original studies, including case reports, cohort studies, and retrospective analyses, discussing the clinical presentation, diagnostic criteria, treatment strategies, and maternal and neonatal outcomes of AFE. The main database used was PubMed, and additional sources such as professional society guidelines and clinical pharmacology references. Study participants: This thesis includes a clinical case analysis of a 29-year-old primigravida postpartum patient with multiple pregnancy-related risk factors diagnosed with suspected AFE. Results: This literature review recognizes the main clinical presentations of AFE, including respiratory failure, cardiovascular collapse, and disseminated intravascular coagulation (DIC). As there is no definitive test for AFE, its diagnosis remains clinical. The main treatment for AFE is supportive care, and extracorporeal membrane oxygenation (ECMO) is reserved for severe cases. The case report presents the successful stabilization and discharge of both mother and newborn after a suspected AFE attack. Conclusions: AFE is a rare, unpredictable, and life-threatening condition. Its diagnosis is mainly based on clinical suspicion and exclusion of other causes. To improve outcomes, it is crucial to recognize AFE early and manage it with multidisciplinary approaches. Future research is needed and should be focused on exploring diagnostic biomarkers and immunological mechanisms to improve early detection and treatment strategies. Recommendations: 1. AFE must be considered in cases of sudden peripartum cardiopulmonary collapse. 2. To improve the survival rates, immediate resuscitation and early intensive care unit (ICU) admission are needed. 3. To optimize maternal and fetal outcomes, it is crucial to involve a multidisciplinary team. 4. AFE diagnostic criteria should be refined to recognize atypical presentations. 5. Future research should explore potential biomarkers and immunological contributors to make an earlier and accurate diagnosis.