Key messages

• Venous and amniotic fluid thromboemboli are the leading cause of maternal mortality in Western countries.

• The increased frequency of venous thromboembolism during pregnancy should be ascribed to the combination of venous stasis with the physiological hypercoagulable state associated with pregnancy. Factors promoting thrombosis are maximally operative near term.

• The amniotic fluid embolism syndrome evolves typically in two successive phases. Presenting features include consistently acute cor pulmonale and, at times, hemorrhage, seizures, and fetal distress, which typically occur during labor and delivery or shortly thereafter. Acute respiratory distress syndrome and left ventricular failure, consumptive coagulopathy, and postanoxic encephalopathy complicate the course in survivors. This syndrome is accounted for by the introduction of abnormal amniotic fluid into the maternal circulation.

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