Amniotic fluid embolism: a report of four probable cases.

Four probable cases of amniotic fluid embolism (AFE) are reviewed. The outcome appeared to be determined by the severity of the insult, and possibly the gestation of the pregnancy, rather than the management of the AFE. Two cases occurred during early labour; neither patient recovered consciousness. One died two weeks later and the other suffered severe permanent cerebral damage. The other two cases occurred during dilatation and curettage, one for therapeutic abortion at fourteen weeks gestation and the other for missed abortion at twenty weeks gestation. Both patients made full recoveries. Disseminated intravascular coagulation (DIC) was a feature of all four cases. In the patients in labour it occurred almost immediately. In those undergoing dilatation and curettage it occurred after the patients had apparently recovered but were under observation in the intensive care unit. Amniotic fluid embolism can occur during an apparently uneventful labour. It should also be suspected when unexplained collapse occurs during second trimester dilatation and curettage. Because severe DIC may follow, such patients should be transferred immediately to a centre with full haemotology services.