Problemsspecial considerations

Features of AFE include sweating, shivering, convulsions, fetal bradycardia, dyspnoea, cyanosis, cardiovascular collapse and disseminated intravascular coagulation (DIC). Collapse is typically profound, rapid and resistant to treatment. Thus the initial problem of AFE is its immediate management.

In addition, there are many causes of sudden collapse (see Chapter 75, Collapse on labour ward, p. 179) and it may be difficult to diagnose the underlying condition. Although the diagnosis of AFE is often based on the demonstration of fetal squames in the maternal circulation or lung, this has been shown to be neither a sensitive nor a specific test, since normal mothers may demonstrate circulating fetal squames whilst 'classic' cases of AFE may not.

A final problem - and one that hinders development of effective methods of prevention and treatment - is the debate over the nature of AFE itself, even whether it represents a separate entity at all (the term 'sudden obstetric collapse syndrome' has been suggested as being more appropriate). Since the mechanism is so poorly understood, the condition remains an enigma.

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