AFE—the known
1. The clinical diagnosis generally rests on one or more of the following
clinical signs/symptoms: (1) cardiovascular collapse, (2) respiratory
distress, (3) coagulopathy, and (4) seizures/coma.
2. The most widely accepted laboratory diagnosis of AFE is the finding
of fetal material in the maternal pulmonary circulation at autopsy.
A promising test is serum insulin-like growth factor 1, which in early
investigations seems specific and sensitive. Finding fetal material in
the circulation of the living is not diagnostic, and the absence of such
material at autopsy is not proof of absence of disease.
3. The incidence of life-threatening AFE is on the order of one in
20,000 to 50,000. More mild forms of the disease might be more
common—and probably are—but there is no consensus on how to
identify these more mild cases.
4. The reported mortality rate has dropped over the years to between
16% and 35%, depending on the study—due in part to better,
population-based studies and reporting as well as improvements
in critical care medicine.
5. The primary mechanism of the disease is probably not anaphylaxis.
6. There is no basis for using the term ‘‘anaphlactoid,’’ specifically
denoting a non-immune-mediated mast cell degranulation