Amniotic fluid embolism as a cause of maternal death

DOI

https://dx.doi.org/10.18565/aig.2026.128

Klimov V.A., Silaev B.V., Shchegolev A.I.
1) Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia; 2) I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia

This paper presents an analysis of the literature on the risk factors, pathophysiological mechanisms and fatal outcomes associated with amniotic fluid embolism in women in labor. It highlights the characteristics of the development of life-threatening complications associated with amniotic fluid embolism, including cardiopulmonary shock, anaphylactoid syndrome and disseminated intravascular coagulation (DIC). It is emphasized that there are no pathognomonic clinical or laboratory manifestations of the disease; consequently, the clinical diagnosis of amniotic fluid embolism is based on the principle of exclusion, which requires a differential diagnosis to be carried out with a whole range of conditions. The article presents the principles of management and the criteria for establishing the final clinical diagnosis in case of maternal death due to amniotic fluid embolism. Objective diagnosis and verification of amniotic fluid embolism are only possible through microscopic examination of histological and immunohistochemical sections of lung tissue obtained from an autopsy.
Conclusion. Amniotic fluid embolism remains a rare but life-threatening complication of pregnancy requiring intensive care.

Authors’ contributions. Klimov V.A., Silaev B.V., Shchegolev A.I. – search and analysis of literary sources, writing and editing the text of the article.
Conflicts of interest. Authors declare lack of the possible conflicts of interests.
Funding. The study was conducted without sponsorship.
Generative Artificial Intelligence. No generative artificial intelligence technologies were used in the preparation of this article.
For citation: Klimov V.A., Silaev B.V., Shchegolev A.I.
Amniotic fluid embolism as a cause of maternal death.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (6): 22-30 (in Russian)
https://dx.doi.org/10.18565/aig.2026.128

amniotic fluid embolism

anaphylactoid syndrome

risk factors

pathogenesis

diagnosis

formulation of the diagnosis

Full text (in Russian)

Meyer J.R. Embolia pulmonar amino caseosa. Bras. Med. 1926; 2: 301-3.
Steiner P.E., Lushbaugh C.C. Maternal pulmonary embolism by fluid as a cause of obstetric shock and unexpected deaths in obstetrics. JAMA. 1941; 117:1245-54. http://dx.doi.org/10.1001/jama.1941.02820410023008
Young B.K., Florine Magdelijns P., Chervenak J.L., Chan M. Amniotic fluid embolism: a reappraisal. J. Perinat. Med. 2023; 52(2): 126-35. https://dx.doi.org/10.1515/jpm-2023-0365
Da Sacco S., Perin L., Sedrakyan S. Amniotic fluid cells: current progress and emerging challenges in renal regeneration. Pediatr. Nephrol. 2018; 33(6):935-45. https://dx.doi.org/10.1007/s00467-017-3711-7
Park H.J., Cho H.Y., Cha D.H. The amniotic fluid cell-free transcriptome provides novel information about fetal development and placental cellular dynamics. Int. J. Mol. Sci. 2021; 22(5): 2612. https://dx.doi.org/10.3390/ijms22052612
Davies S. Amniotic fluid embolus: a review of the literature. Can. J. Anaesth. 2001; 48(1): 88-98. https://dx.doi.org/10.1007/BF03019822
Kobayashi H. The entry of fetal and amniotic fluid components into the uterine vessel circulation leads to sterile inflammatory processes during parturition. Front. Immunol. 2012; 3: 321. https://dx.doi.org/10.3389/fimmu.2012.00321
Clark S.L., Hankins G.D., Dudley D.A., Dildy G.A., Porter T.F. Amniotic fluid embolism: analysis of the national registry. Am. J. Obstet. Gynecol. 1995;172(4 Pt 1): 1158-69. https://dx.doi.org/10.1016/0002-9378(95)91474-9
Shaikh N., Alhammad M.F., Nahid S., Umm E.A., Fatima I., Ummunnisa F. et al. Amniotic fluid embolism causing multiorgan embolisms and reinforces the need for point-of-care ultrasound. Qatar Med. J. 2023; 2023(1): 13. https://dx.doi.org/10.5339/qmj.2023.13
Greenberger P.A., Ditto A.M. Chapter 24: Anaphylaxis. Allergy Asthma Proc. 2012; 33(Suppl 1): 80-3. https://dx.doi.org/10.2500/aap.2012.33.3557
Benson M.D. Nonfatal amniotic fluid embolism. Three possible cases and a new clinical definition. Arch. Fam. Med. 1993; 2(9): 989-94. https://dx.doi.org/10.1001/archfami.2.9.989
Kobayashi H. Amniotic fluid embolism: anaphylactic reactions with idiosyncratic adverse response. Obstet. Gynecol. Surv. 2015; 70(8): 511-7. https://dx.doi.org/10.1097/OGX.0000000000000197
Motta G., Juliano L., Shariat-Madar Z. Kallikrein-kinin system: insights into a multifunctional system. Front. Physiol. 2023; 14: 1305981. https://dx.doi.org/10.3389/fphys.2023.1305981
Oi H., Naruse K., Noguchi T., Sado T., Kimura S., Kanayama N. et al. Fatal factors of clinical manifestations and laboratory testing in patients with amniotic fluid embolism. Gynecol. Obstet. Invest. 2010; 70(2): 138-44. https://dx.doi.org/10.1159/000313302
Fudaba M., Tachibana D., Misugi T., Nakano A., Koyama M. Excessive fibrinolysis detected with thromboelastography in a case of amniotic fluid embolism: fibrinolysis may precede coagulopathy. J. Thromb. Thrombolysis. 2021; 51(1): 818-20. https://dx.doi.org/10.1007/s11239-020-02237-x
Yang R.L., Lang M.Z., Li H., Qiao X.M. Immune storm and coagulation storm in the pathogenesis of amniotic fluid embolism. Eur. Rev. Med. Pharmacol. Sci. 2021; 25(4): 1796-803. https://dx.doi.org/10.26355/eurrev_202102_25073
Арестова И.М., Жукова Н.П., Киселева Н.И. Эмболия околоплодными водами (ЭОВ) или анафилактоидный синдром беременности (АСБ). Часть 2. Синдром диссеминированного внутрисосудистого свертывания (ДВС-синдром). Охрана материнства и детства. 2018; 2(32): 38-45. [Arestova I.M., Zhukova N.P., Kiseleva N.I. Amniotic fluid embolism (AFE) or anaphylactoid syndrome of pregnancy (ASP). Part 2. Disseminated intravascular coagulation syndrome (DIC-syndrome). Maternal and Child Health. 2018; 2(32): 38-45 (in Russian)].
Conde-Agudelo A., Romero R. Amniotic fluid embolism: an evidence-based review. Am. J. Obstet. Gynecol. 2009; 201(5): 445.e1-13. https://dx.doi.org/10.1016/j.ajog.2009.04.052
Sisodia S.M., Bendale K.A., Khan W.A. Amniotic fluid embolism: a cause of sudden maternal death and police inquest. Am. J. Forensic Med. Pathol. 2012; 33(4): 330-4. https://dx.doi.org/10.1097/PAF.0b013e31825fb201
Jo E.A., Jung S.K., Lee J.H., Kim J.O., Choi H.E., Joo H.S. et al. Amniotic fluid embolism: maternal disseminated intravascular coagulation, cardiovascular collapse, and acute hypoxic cases shortly after delivery. Perinatology. 2018; 29(2): 89. https://dx.doi.org/10.14734/PN.2018.29.2.89
Серов В.Н., Сухих Г.Т., Курцер М.А., Радзинский В.Е., ред. Акушерство. Национальное руководство. М.: ГЭОТАР-Медиа; 2026. 1048 с. [Serov V.N., Sukhikh G.T., Kurzer M.A., Radzinsky V.E., eds. Obstetrics. National guide. Moscow: GEOTAR-Media; 2026. 1048 p. (in Russian)].
Gentilomo A., Tambuzzi S., Gentile G., Boracchi M., Andreola S., Zoia R. Post-mortem diagnosis of amniotic fluid embolism. Autops. Case Rep. 2024; 14: e2024472. https://dx.doi.org/10.4322/acr.2024.472
Clark S.L., Romero R., Dildy G.A., Callaghan W.M., Smiley R.M., Bracey A.W. et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am. J. Obstet. Gynecol. 2016; 215(4): 408-12. https://dx.doi.org/10.1016/j.ajog.2016.06.037
Fitzpatrick K.E., van den Akker T., Bloemenkamp K.W.M., Deneux-Tharaux C., Kristufkova A., Li Z. et al. Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study. PLoS Med. 2019; 16(11): e1002962. https://dx.doi.org/10.1371/journal.pmed.1002962
Rath W.H., Hoferr S., Sinicina I. Amniotic fluid embolism: an interdisciplinary challenge: epidemiology, diagnosis and treatment. Dtsch. Arztebl. Int. 2014; 111(8): 126-32. https://dx.doi.org/10.3238/arztebl.2014.0126
Conde-Agudelo A., Romero R. Amniotic fluid embolism: an evidencebased review. Am. J. Obstet. Gynecol. 2009; 201(5): 445.e1-13. https://dx.doi.org/10.1016/j.ajog.2009.04.052
Toy H. Amniotic fluid embolism. Eur. J. Gen. Med. 2009; 6(2): 108-15.
Moore J. Amniotic fluid embolism: on the trail of an elusive diagnosis. Lancet. 2006; 368(9545): 1399-401. https://dx.doi.org/10.1016/S0140-6736(06)69581-0
Филиппов О.С., Гусева Е.В. Материнская смертность в Российской Федерации в 2019 г. Проблемы репродукции, 2020; 26(6-2): 8-26. https://dx.doi.org/10.17116/repro2020260628 [Filippov O.S., Guseva E.V. Maternal mortality in the Russian Federation in 2019. Russian Journal of Human Reproduction. 2020; 26(6-2): 8-26 (in Russian). https://dx.doi.org/10.17116/repro2020260628].
Серов В.Н. Профилактика материнской смертности. Акушерство и гинекология. 2011; 7-1: 4-10. [Serov V.N. Prevention of maternal mortality. Obstetrics and Gynecology. 2011; (7-1): 4-10 (in Russian)].
Stafford I.A., Moaddab A., Dildy G.A., Klassen M., Berra A., Watters C. et al. Amniotic fluid embolism syndrome: analysis of the Unites States International Registry. Am. J. Obstet. Gynecol. MFM. 2020; 2(2): 100083. https://dx.doi.org/10.1016/j.ajogmf.2019.100083
Fitzpatrick K.E., Tuffnell D., Kurinczuk J.J., Knight M. Incidence, risk factors,management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study. BJOG. 2016; 123(1): 100-9. https://dx.doi.org/10.1111/1471-0528.13300
Щеголев А.И., Туманова У.Н., Ляпин В.М., Серов В.Н. Синцитиотрофобласт ворсин плаценты в норме и при преэклампсии. Акушерство и гинекология. 2020; 6: 21-8. https://dx.doi.org/10.18565/aig.2020.6.21-28 [Shchegolev A.I., Tumanova U.N., Lyapin V.N., Serov V.N. The syncytiotrophoblast of the placental villi in health and in preeclampsia. Obstetrics and Gynecology. 2020; (6): 21-8 (in Russian). https://dx.doi.org/10.18565/aig.2020.6.21-28].
Benson M.D. Amniotic fluid embolism: the known and not known. Obstet. Med. 2014; 7(1): 17-21. https://dx.doi.org/10.1177/1753495X13513578
Attwood H.D., Park W.W. Embolism to the lungs by trophoblast. J. Obstet. Gynaecol. Br. Commonw. 1961; 68: 611-7. https://dx.doi.org/10.1111/j.1471-0528.1961.tb02778.x
Щеголев А.И., Ляпин В.М., Туманова У.Н., Воднева Д.Н., Шмаков Р.Г. Гистологические изменения плаценты и васкуляризация ее ворсин при ранней и поздней преэклампсии. Архив патологии. 2016; 78(1): 13-8. https://dx.doi.org/10.17116/patol201678113-18 [Shchegolev A.I., Lyapin V.M., Tumanova U.N., Vodneva D.N., Shmakov R.G. Histological hanges in the placenta and vascularization of its villi in early- and late-onset preeclampsia. Russian Journal of Archive of Pathology. 2016; 78(1): 13-8 (in Russian). https://dx.doi.org/10.17116/patol201678113-18].
Yamashita A., Oda T., Aman M., Wakasa T., Gi T., Ide R. et al. Massive platelet-rich thrombus formation in small pulmonary vessels in amniotic fluid embolism: An autopsy study. BJOG. 2023; 130(6): 1685-96. https://dx.doi.org/10.1111/1471-0528.17532
Fineschi V., Riezzo I., Cantatore S., Pomara C., Turillazzi E., Neri M. Complement C3a expression and tryptase degranulation as promising histopathological tests for diagnosing fatal amniotic fluid embolism. Virchows Arch. 2009; 454(3):283-90. https://dx.doi.org/10.1007/s00428-009-0730-1
Tuller M.A. Amniotic fluid embolism, afibrinogenemia, and disseminated fibrin thrombosis; case report and review of the literature. Am. J. Obstet. Gynecol. 1957; 73(2): 273-87. https://dx.doi.org/10.1016/s0002-9378(16)37344-6
Attwood H.D., Delprado W.J. Amniotic fluid embolism: fatal case confirmed at autopsy five weeks after delivery. Pathology. 1988; 20(4): 381-2. https://dx.doi.org/10.3109/00313028809085224
Kaptanoglu M., Dogan K., Onen A., Cevit R., Berkan O., Aker H. Lung mass due to amniotic fluid embolism - an intrathoracic complication of pregnancy. Scand. Cardiovasc. J. 1999; 33(2): 117-9. https://dx.doi.org/10.1080/14017439950141939
Доросевич А.Е., Дмитриев И.В. Морфологическая диагностика жировой эмболии. Судебно-медицинская экспертиза. 2016; 59(1): 43-7. https://dx.doi.org/10.17116/sudmed201659143-47 [Dorosevich A.E., Dmitriyev I.V. Morphological diagnostics of fat embolism. Forensic Medical Expertise. 2016; 59(1): 43-7 (in Russian). https://dx.doi.org/10.17116/sudmed201659143-47].
Schrufer-Poland T., Singh P., Jodicke C., Reynolds S. Nontraumatic fat embolism found following maternal death after cesarean delivery. Am. J. Perinatol. Rep. 2015; 5(1): e1-5. https://dx.doi.org/10.1055/s-0034-1394153
Shaikh N. Emergency management of fat embolism syndrome. J. Emerg. Trauma Shock. 2009; 2(1): 29-33. https://dx.doi.org/10.4103/0974-2700.44680
Mohtarrudin N., Ismail I.I. Fatal Non-traumatic fat embolism. Mal. J. Med. Health Sci. 2020; 16 (SUPP9): 120-2.
Stump B., Weinhouse G. Fat embolism syndrome: fact or myth? Curr. Trauma Rep. 2016; 2(2): 66-72. https://dx.doi.org/10.1007/s40719-016-0042-2
Gurd A.R. Fat embolism: an aid to diagnosis. J. Bone Joint Surg. 1970; 52(4): 732-7.
Schonfeld S.A., Ploysongsang Y., DiLisio R., Crissman J.D., Miller E., Hammerschmidt D.E. et al. Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann. Intern. Med. 1983; 99(4): 438-43. https://dx.doi.org/10.7326/0003-4819-99-4-438
Husebye E.E., Lyberg T., Roise O. Bone marrow fat in the circulation: clinical entities and pathophysiological mechanisms. Injury. 2006; 37(Suppl 4): S8-18. https://dx.doi.org/10.1016/j.injury.2006.08.036
Karayel F., Arican N., Kavas G., Turan A.A., Pakis I. Maternal death due to non-traumatic fat embolism. J. Forensic Sci. 2005; 50(5): 1201-3.
Sinha A., Olah K.S.J. Acute fatty liver of pregnancy: an unusual presentation. J. Obstet. Gynaecol. 2005; 25(1): 60-1. https://dx.doi.org/10.1080/01443610400025655

Received 20.04.2026

Accepted 17.06.2026

Vladimir A. Klimov, PhD, Head of the Service for Organization of Medical Care and Information Service, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Heath of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, +7(977)937-67-27, va_klimov@oparina4.ru;
https://orcid.org/0000-0002-4699-7614
Borislav V. Silaev, PhD, Associate Professor at the Department of Anesthesiology and Intensive Care, I.M. Sechenov First Moscow State Medical University, Ministry of Heath of Russia; Head of the Department of Anesthesiology-Intensive Care of the Institute of Anesthesiology-Intensive Care and Transfusiology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Heath of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, b_silaev@oparina4.ru,
https://orcid.org/0000-0002-9698-3915
Alexander I. Shchegolev, Dr. Med. Sci., Professor, Head of the 2nd Pathology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Heath of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, ashegolev@oparina4.ru, https://orcid.org/0000-0002-2111-1530

Amniotic fluid embolism as a cause of maternal death

Klimov V.A., Silaev B.V., Shchegolev A.I.

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