Initial management of acute circulatory failure in amniotic fluid embolism: A narrative review

Amniotic fluid embolism is an obstetric complication that occurs when amniotic fluid, fetal cells, or other fetus components enter the maternal pulmonary circulation, leading to acute cardiovascular decompensation during and immediately following delivery. The pathogenesis of amniotic fluid embolism remains uncertain and fulminant activation of cytokines can potentially contribute to hemodynamic collapse. Currently, there are no specific biomarkers available for definitive diagnosis. Amniotic fluid embolism diagnosis is established on the clinical judgment after excluding other potential causes of circulatory collapse. Management of acute circulatory failure requires a multidisciplinary approach in which the primary goals are to optimize right ventricular preload, vasopressors and/or inotropes to maintain tissue perfusion, addressing the cornerstone of hemorrhage control and coagulopathy management, and extracorporeal membrane oxygenation cannulation has demonstrated safety in providing resuscitation and improving prognosis. Consideration of activating local or mobile extracorporeal membrane oxygenation at the time of diagnosis is the key to the management of amniotic fluid embolism.