Learning Zone: Amniotic Fluid Embolism. Matthew Robinson

Topic of the month Date
Amniotic Fluid Embolism
October 2021
Relevant recent publications
Rotational thromboelastometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism. Loughran JA, Kitchen TL, Sindhakar S, Ashraf M, Awad M, Kealaher EJ
Int J Obstet Anesth. 2019;38:127

Risk factors, management, and outcomes of amniotic fluid embolism: A multi-country, population-based cohort and nested case-control study.
Fitzpatrick KE, van den Akker T, Bloemenkamp KWM, Deneux-Tharaux C, Kristufkova A, Li Z, Schaap TP, Sullivan EA, Tuffnell D, Knight M. PLOS Medicine. 2019;16(11):e1002962.

Maternal Death Due to Amniotic Fluid Embolism: A National Study in France.
Bonnet MP, Zlotnik D, Saucedo M, Chassard D, Bouvier-Colle MH, Deneux-Tharaux C, French National Experts Committee on Maternal Mortality
Anesth Analg. 2018;126(1):175.

Pulmonary vascular obstruction by squamous cells is not involved in amniotic fluid embolism.
Funk M, Damron A, Bandi V, Aagaard K, Szigeti R, Clark S
Am J Obstet Gynecol. 2018;218(4):460

Amniotic Fluid Embolism
Y Metodiev, P Ramasam, D Tuffness
BJA Education. 2018. Volume 18, Issue 8, p227-258

Amniotic fluid embolism: Pathophysiology from the perspective of pathology.
Tamura N, Farhana M, Oda T, Itoh H, Kanayama N
J Obstet Gynaecol Res. 2017;43(4):627. Epub 2017 Feb 11.

OAA webcast (in last 4 years) ECMO in pregnancy
Dr Guy Glover
Cases and clinical challenges, Church House, 6th March 2019
Password: 2019

Maternal mortality and the role of the anaesthetist
Professor Cynthia Wong
Three day course in obstetric anaesthesia – 5th-7th November 2018
Password: London

MBRRACE – an update from the latest report
Dr Jim Bamber
Obstetric Anaesthesia – 24th-25th May 2018
Password: Titanic

Maternal Collapse
Dr Roshan Fernando
Three Day Course in Obstetric Anaesthesia – 6th- 8th November 2017
Password: bonfire

Amniotic Fluid Embolism: Current concepts
Clinical Associate Professor Nolan McDonnell

OAA posters (in last 4 years) Obstetric Anaesthesia Conference, June 2021, Virtual
Amniotic fluid embolism: a description of coagulopathy

Obstetric Anaesthesia Conference, 2020.
Amniotic fluid embolism: An intraoperative cardiac arrest

Obstetric Anaesthesia Conference, 2020.
Amniotic fluid embolism with multiple cerebral emboli

MBRRACE-UK MBRRACE Report - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18
Chapter 7 - Lessons for care of women with haemorrhage or amniotic fluid embolism

MBRRACE-UK: Saving Lives, Improving Mothers’ Care 2020 – Course week 3 - Presentation 2: Care of women with haemorrhage or AFE by Derek Tuffnell

National guidelines RCOG Green-top Guideline No.56 – Maternal Collapse in Pregnancy and the Puerperium

RCOG Green-top Guideline No. 52: Prevention and Management of Postpartum Haemorrhage -

OAA Obstetric Cardiac Arrest Algorithm 2021
International guidelines South Australian Perinatal Practice Guidelines - Amniotic Fluid Embolism

Society for Maternal-Fetal Medicine Special Statement: Checklist for initial
management of amniotic fluid embolism

Audit / Qu suggestions
GPAS chapter 7 Chapter 9: Guidelines for the Provision of Anaesthesia Services for an Obstetric Population 2020.
Simulation-based learning techniques should be used to assist anaesthetists to resolve these issues and develop the necessary technical and non-technical skills.
For evidence for requirements for MDT training in maternal resuscitation see Maternity incentive scheme.
Core competencies must be included in the training programme. Training for management of maternal resuscitation is part of these competencies.
FRCA questions When was it asked?
Sept 2011, Question 5
What was asked?
- What were the direct causes of maternal mortality in the CEMACE report?
- Clinical presentation of AFE
- Differential diagnoses of AFE
- Describe 2 pathophysiological theories of AFE
Simulation suggestion
Maternity incentive scheme requires local MDT training to be in place. Core competencies must be included in the training programme. Training for management of maternal resuscitation is part of these competencies.

Maternal collapse during induction of labour as a result of amniotic fluid embolism simulation
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