Key messages

• Respiratory failure is usually the cardinal presenting feature of obstetric emboli, whatever their origin. Numerous other conditions, whether specifically related to pregnancy or not, may produce the same symptoms and must be carefully excluded.

• The diagnostic work-up and management of venous thromboembolism during pregnancy is basically similar to that for the non-pregnant patient. A diagnosis should be aggressively sought because of the therapeutic implications for the mother. Prompt attention to both maternal oxygenation and hemodynamic status is essential for fetal well being. Promotion of thrombus resolution and prevention of thrombus extension and dislodgement are further therapeutic priorities. These goals are best achieved with heparin and, at times, thrombolytic agents. The use of Coumadin (warfarin) should be restricted to the puerperium.

• The diagnosis of amniotic fluid embolism should be based on a typical clinical picture, i.e. the triad of hypotension, hypoxemia, and coagulopathy, that usually occurs around delivery. Treatment is mainly supportive and should be primarily directed at maternal oxygenation. Owing to inconsistent hemodynamic findings, cardiorespiratory management should be guided by pulmonary catheterization in those patients affected by successive right and left ventricular failure and potential alveolar-capillary membrane injury.

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