Amniotic fluid embolism: a review of the literature with two case reports.

Amniotic fluid embolism (AFE) is a rare but dramatic obstetric complication. In this study, the pathogenesis of AFE and the disorders of coagulation and fibrinolysis and postmortem gross pathologic and histologic findings resulting from it are reviewed. The 2 case histories examined in this report exemplify different clinical courses of amniotic fluid embolism. In the first case, there was a predominant activation of the coagulation system, with a fatal outcome. In the second case, generalized fibrinolysis dominated, and the woman survived. Finally, the authors wish to emphasize that the administration of fibrinogen is an incorrect approach to the management of this syndrome. A combination of Macrodex and heparin might be effective in preventing the formation of microthrombi, but increased fibrinolysis has to be treated by a sufficiently high dose of fibrinolytic inhibitors.