AFE definition

Q: Whats the diagnostic criteria of Amniotic Fluid Embolism (AFE)? 

 Answer: 

 Working group of the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation proposed a definition of AFE based on the presence of four diagnostic criteria, all of which must be present

• Sudden onset of cardiorespiratory arrest or hypotension (systolic blood pressure < 90) with evidence of respiratory compromise
• Documentation of overt DIC using the scoring system of the Scientific and Standardization Committee on DIC of the International Society on Thrombosis and Haemostasis (ISTH), modified for pregnancy (see reference # 2)
• Clinical onset during labor or within 30 minutes of placental delivery. 
•  Absence of fever (≥38°C) during labor

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References:

1. Clark SL, Romero R, Dildy GA, et al. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol 2016; 215:408. 

2. Toh CH, Hoots WK, SSC on Disseminated Intravascular Coagulation of the ISTH. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost 2007; 5:604. 

3. Stafford IA, Moaddab A, Dildy GA, et al. Evaluation of proposed criteria for research reporting of amniotic fluid embolism. Am J Obstet Gynecol 2019; 220:285.