Q: 32 year old 26 weeks pregnant female brought to ER with  shortness of breath, requiring intubation in field and severe hypotension. According to husband she complains of some coughing and 'unpleasant taste in the mouth', followed by shivering and shortness of breath. What is your concern?

Answer:  Amniotic fluid Emboli

Amniotic fluid emboli is a fatal complication of pregnancy marked by hemodynamic collapse and coagulopathy. Amniotic fluid enters mother circulation along with fetal cells, hair and other debris and trigger an allergic reaction. One diagnostic clue is history of "premonitory symptoms" consists of shivering, coughing, vomiting, and an unpleasant taste in the mouth.

Diagnosis can be made via Pulmonary Artery Catheter insertion and obtaining fetal debris from pulmonary artery. Treatment is supportive.