What is amniotic fluid embolism (AFE)?
Amniotic fluid embolism (AFE) is a rare but life-threatening obstetric emergency that occurs when amniotic fluid, fetal cells, hair, or other debris enter the maternal bloodstream and trigger a severe immune response.
While extremely uncommon, AFE can happen suddenly during labor, delivery, or the immediate postpartum period, and it requires rapid recognition and intervention to save lives.
For clinicians working in obstetrics and labor and delivery (L&D), awareness of this complication is critical. Although prevention is challenging, preparation and prompt multidisciplinary care can improve outcomes for both mother and baby.
What causes amniotic fluid embolism?
The exact cause of AFE remains unknown, but the leading theory suggests that amniotic fluid or fetal material enters the maternal circulation through tears in the placental membranes or uterine veins. This can trigger a cascade of events—from severe allergic-type reactions to life-threatening cardiorespiratory collapse.
Possible contributing factors
While AFE can occur without any obvious warning, certain conditions may increase risk:
- Advanced maternal age: Pregnancies in people aged 35 or older
- Cesarean delivery or instrumental birth: Forceps or vacuum extraction may increase the chance of fluid entry into the bloodstream
- Placenta previa or placental abruption: Conditions that disrupt placental integrity
- Multiple gestations: Higher risk of uterine overdistension
- Severe trauma during pregnancy: Such as uterine rupture or abdominal injury
- Induction of labor: Especially with high uterotonic doses
Clinicians in acute care and intensive care settings may encounter patients transferred from L&D units with suspected AFE, making inter-unit coordination essential.
Recognizing amniotic fluid embolism symptoms
AFE often presents suddenly and progresses rapidly. Recognizing the signs in their earliest stages can make a life-saving difference.
Common symptoms include:
- Sudden shortness of breath: Rapid-onset respiratory distress is often the first sign
- Hypotension and shock: Severe drop in blood pressure due to cardiovascular collapse
- Seizures: May occur in the initial phase
- Cardiac arrest: Often follows immediately after respiratory symptoms
- Coagulopathy or disseminated intravascular coagulation (DIC): Can lead to uncontrolled bleeding
- Fetal distress: Non-reassuring fetal heart patterns in labor
These symptoms usually appear during active labor, delivery, or within minutes to hours postpartum. For labor and delivery nurses, rapid assessment and initiation of emergency protocols are vital to maternal and neonatal survival.
How is amniotic fluid embolism treated?
There is no specific cure for AFE—treatment focuses on immediate stabilization and supportive care.
Typical emergency interventions include:
- Cardiopulmonary resuscitation (CPR): Initiated at the first sign of cardiac arrest
- Advanced airway and respiratory support: Often requiring mechanical ventilation
- Hemodynamic stabilization: Use of vasopressors and fluids to maintain blood pressure
- Blood products: Transfusions to manage massive hemorrhage and correct coagulopathy
- Multidisciplinary response: Coordination among obstetricians, anesthesiologists, ICU teams, and cardiac nursing specialists
Survival depends heavily on speed. Successful cases are often linked to teams that recognized symptoms early and responded within minutes.
Amniotic fluid embolism prevention: What we know
Unfortunately, there is no guaranteed way to prevent AFE because it is unpredictable and rare. However, clinicians can reduce risks and improve preparedness through the following:
- Identifying high-risk patients: Older maternal age, placenta complications, or multiple gestations
- Close monitoring during delivery: Especially in high-acuity, labor and delivery units
- Rapid response training: Regular simulation drills for obstetric emergencies
- Collaborative care planning: Involving OB/GYN nurses, nurse midwives, and physicians for coordinated monitoring
While “how to prevent amniotic fluid embolism?” remains a challenging question, the best defense lies in vigilance, rapid recognition, and readiness to initiate advanced life support without delay.
A personal reminder of AFE’s impact
The tragic loss of Hailey Okula, a dedicated ER nurse and nursing influencer, underscores just how devastating amniotic fluid embolism can be. Known online as “Nurse Hailey,” she inspired and supported countless new nurses through her “RN New Grads” platform while openly sharing her personal journey into motherhood. Following the birth of her son via cesarean section, Hailey developed an amniotic fluid embolism.
Her story is not only heartbreaking for her family and the nursing community, but it is also a reminder of the unpredictable nature of AFE. Despite its rarity, this condition can turn a joyful delivery into a medical emergency within moments.
For clinicians, Hailey’s passing highlights the importance of ongoing training, interdisciplinary readiness, and rapid intervention protocols in labor and delivery units.
While statistics emphasize how infrequently AFE occurs, each case represents profound loss. By honoring Hailey’s legacy and raising awareness, the healthcare community can continue to strengthen preparedness and advocate for safer births—ensuring that her impact on nursing lives on through education, vigilance, and compassion.
Pregnancy after AFE: What to know about a second pregnancy
Understandably, survivors may have concerns about future pregnancies. Research on recurrence is limited, but available data suggest that the recurrence risk is low—although higher than in the general population.
Considerations for planning a second pregnancy include:
- Pre-pregnancy counseling: Detailed review of prior AFE event and health status
- Delivery in a high-acuity center: Facilities equipped with advanced obstetric, ICU, and surgical resources
- Enhanced prenatal monitoring: Frequent check-ins and readiness planning with the obstetric team
- Multidisciplinary care plan: Engagement of obstetricians, anesthesiologists, and critical care teams in advance
These steps can help AFE survivors approach a second pregnancy with greater safety and confidence.
The role of skilled healthcare professionals in managing AFE
AFE is an “all hands on deck” emergency, requiring immediate, expert action. Having skilled, experienced clinicians—including PRN labor and delivery nurses—on shift can be the difference between life and death.
Platforms like Nursa connect facilities with qualified, independent nurse contractors quickly, ensuring that labor and delivery units have the staff they need when high-risk cases or emergencies arise.
For nurses, Nursa offers opportunities to pick up per diem shifts in L&D and related specialties, ensuring that their skills are available where and when they’re needed most.
Raising awareness and supporting safer births
Amniotic fluid embolism remains one of the most unpredictable and dangerous complications in obstetrics, but awareness, preparation, and rapid action save lives. For labor and delivery teams, ongoing training and access to qualified backup staff are critical to emergency readiness.
AFE may be rare, but for clinicians, knowing the risk factors, symptoms, treatment approaches, and preventive strategies ensures that when it strikes, they are ready to respond.
Through teamwork, skill, and preparedness, healthcare professionals can continue to improve maternal and neonatal outcomes—even in the most challenging moments of birth.
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