AFE FAQs
What is Amniotic Fluid Embolism?
- Last Updated: July 21, 2025
Amniotic fluid embolism (AFE) is a sudden and unexpected life-threatening birth complication. It can affect both the mother and the baby. It is believed to be an allergic-like reaction to the amniotic fluid that enters the mother’s bloodstream. Amniotic fluid entering the bloodstream is a normal part of the birth process. An AFE usually occurs around the time of labor, delivery, or c-section but can also occur during an amniocentesis or D&E procedure.
AFE is a complex medical condition that can be very difficult to understand. Below, is a list of frequently asked questions to help you become more familiar with AFE.
Frequently Asked Questions
What is an amniotic fluid embolism and how is it treated?
Amniotic fluid embolism (AFE) is a sudden and unexpected life-threatening birth complication. It can affect both the mother and the baby. It is believed to be an allergic-like reaction to the amniotic fluid that enters the mother’s bloodstream. Amniotic fluid entering the bloodstream is a normal part of the birth process. An AFE usually occurs around the time of labor, delivery, or c-section but can also occur during an amniocentesis or D&E procedure.
An AFE involves two life-threatening complications;
- Heart and lung failure (cardiorespiratory collapse) and
- Severe bleeding (disseminated intravascular coagulopathy or DIC).
By themselves, each of these is serious and life-threatening. Together, they require immediate and aggressive medical care.
Heart and lung failure cause breathing problems, irregular heartbeat, and seizures. It can lead to cardiac arrest- when the heart stops beating. When the heart stops beating, it cannot send oxygenated blood to the body. Lack of oxygen to the body can cause organ failure and brain damage.
Treatment of heart and lung failure includes:
- Oxygenating the body by placing a breathing tube (intubation)
- Cardiopulmonary resuscitation (CPR)
- Medications to help manage blood pressure and help the heartbeat
Bleeding is a normal process of birth. Women who experience an AFE have sudden and excessive bleeding (hemorrhage). This can lead to a condition known as disseminated intravascular coagulopathy (DIC). DIC causes the over-development of blood clots throughout the bloodstream. This increased clotting depletes the body’s platelets and clotting factors needed to control bleeding. Excessive bleeding may lead to complications including stroke, organ failure, and heart failure.
Treatment of hemorrhage and DIC includes:
- Blood transfusions
- Surgical procedures
- Medications to help control bleeding
- Medications to replenish the body’s blood volume
Not all hospitals have access to these types of treatments.
What are the signs and symptoms of amniotic fluid embolism?
Early signs and symptoms of amniotic fluid embolism develop suddenly and may include:
- Increased anxiety
- An impending sense of doom
- Fetal distress
- Agitation
- Confusion
- Nausea or vomiting
- Chills
- Skin discoloration
- Shortness of breath
- Abnormal vital signs
These may lead to more serious complications including:
- Loss of consciousness
- Seizure
- Heart and lung failure
- Cardiac arrest
- Excessive and uncontrolled bleeding
- Disseminated intravascular coagulation (DIC)
- Stroke
- Acute respiratory distress syndrome
- Brain damage
- Death
What causes an amniotic fluid embolism?
Doctors and scientists still don’t fully understand what causes amniotic fluid embolism.
Recent studies suggest that AFE may happen when the mother’s immune system overreacts to certain substances from the baby or mother—like amniotic fluid or fetal cells—that enter the mother’s bloodstream during childbirth, medical procedures, or injury. Even though these substances often enter the bloodstream during birth, most women don’t have this kind of reaction.
In the past, experts thought AFE was caused just by amniotic fluid getting into the mother’s blood or blocking the lungs. But now we know that many women have amniotic fluid in their bloodstream during labor and don’t get sick, so those older ideas are no longer believed to be true.
Scientists are still doing research to better understand what causes AFE.
When can an amniotic fluid embolism occur?
An amniotic fluid embolism occurs during pregnancy. Typically, it occurs nearest to the time of delivery or up to an hour after delivery of the placenta.
It can occur during both vaginal and C-section births.
It can occur during any pregnancy. It may happen in a woman’s first pregnancy or after she has had healthy pregnancies before.
Although considered to be rare, AFE can occur during these as well:
- D&E (a surgical procedure on the fetus, placenta, and other tissue)
- Amniocentesis (a test where the fluid is taken from the womb)
- Trauma (car accident, fall, etc.).
How often does an amniotic fluid embolism occur?
The exact number of AFE cases is hard to know for sure. There is no specific test or scan to confirm AFE. Doctors only diagnose it after ruling out all other possible causes, which makes it difficult to track accurately. Because of this, AFE may sometimes be reported too often or not often enough.
Based on recent data, AFE happens in about 2.5 out of every 100,000 births. That’s around 1 in 40,000 births in the United States and 1 in 53,800 in Europe. (It’s important to know that the accuracy of these numbers isn’t always confirmed.)
To understand it better:
- In the U.S., with about 4 million births each year, around 100 women may experience an AFE.
- In the UK, with around 700,000 births each year, about 13 women may be affected.
How is an amniotic fluid embolism diagnosed?
Amniotic fluid embolism is a diagnosis of exclusion, which means doctors only consider it after they have ruled out all other possible causes of the symptoms. Unlike diseases like cancer or injuries like a broken bone, there is no blood test or scan that can confirm AFE.
It can take several days—or even months, especially if the mother passes away—for doctors to make the diagnosis. The medical team usually holds a formal review of the case, carefully looking at the timing of symptoms, test results, and images to make sure nothing else explains what happened.
If the mother dies, an autopsy is strongly recommended. It helps rule out other causes and gives the care team more answers.
In the past, doctors believed AFE could only be diagnosed after death by finding fetal material (like cells from the baby) in the mother’s lungs or blood. But now we know that many women have fetal material in their blood during labor and never show any symptoms of AFE, so this is no longer a reliable way to diagnose it.
How likely is someone to survive an amniotic fluid embolism?
The chances of surviving an amniotic fluid embolism depend on many different factors, so it’s hard to give an exact survival rate. Some of the things that can affect survival include:
- How each woman’s immune system reacts
- Where the birth happens (home, birth center, or hospital)
- What kind of hospital it is and what services are available (such as an ICU, NICU, blood bank, or special life support equipment like ECMO)
- Whether the AFE happens before or after the baby is delivered
- How quickly the medical team recognizes the emergency and begins treatment
- Whether the mother has any other health problems (like high blood pressure or issues with the placenta)
Studies have shown different survival rates, ranging anywhere from 20% to 60%, depending on how and when the data was collected.
Thanks to improvements in emergency and maternity care, survival has increased over the last 20 years. But even with these advances, AFE remains one of the most dangerous and difficult birth complications to treat.
Outcomes can vary a lot. Some women may recover quickly, while others may suffer serious complications like a stroke, brain injury, organ failure, or sadly, may pass away within hours of showing symptoms.
Does an amniotic fluid embolism affect the baby?
If the baby is delivered before the mother shows any symptoms of AFE, the baby is usually healthy and not likely to have any long-term health problems related to the AFE.
If the baby is delivered after the mother starts showing symptoms, the delivery is often an emergency (such as a C-section, forceps, or vacuum delivery). These babies may have low Apgar scores and could have trouble getting enough oxygen, which means they’ll need immediate medical care.
Most babies born during an AFE event are taken to the NICU (neonatal intensive care unit), either for treatment or close observation.
A baby’s chance of survival mostly depends on how well they are getting oxygen at birth and how well they respond to treatment to protect their brain.
Doctors usually recommend that these babies be closely monitored for up to 18 months to make sure they are meeting their developmental milestones.
What are the long term effects for women who survive an amniotic fluid embolism?
Many women who survive an AFE experience long-term or even life-long health problems. These can be mild or severe and vary from person to person based on how their body reacted, their medical history, and even their genetics. The list below comes from over 1,000 AFE survivors who shared their experiences with physical and mental health challenges.
Physical Health Effects
- Memory problems or trouble finding words
- Temporary or lasting heart damage
- Partial or full hysterectomy (removal of the uterus)
- Stroke-related issues (such as difficulty walking, moving, speaking, seeing, or hearing)
- Sheehan’s syndrome (a rare condition affecting hormones after major blood loss)
- Digestive problems
- Pelvic floor problems
- Nerve pain or overall body pain
- Kidney problems that may require dialysis or a transplant
- Brain or nerve damage (mild to severe)
Mental Health Effects
Most survivors—and even their family members—are at higher risk for emotional and mental health struggles after such a traumatic experience.
Common feelings include:
- Confusion
- Guilt
- Loneliness / Isolation
- Anxiety
- Depression
- Post-traumatic stress (PTSD)
Getting help for mental health is a very important part of healing after AFE. Survivors and their loved ones should work closely with their doctors to keep track of both physical and emotional health over time.
What are the risk factors for amniotic fluid embolism?
It’s hard to know exactly what increases the risk of AFE. Because AFE is so rare and happens without warning, it’s difficult for scientists and doctors to study.
Some research suggests that AFE may be linked to:
- Being an older mother (advanced maternal age)
- Carrying more than one baby (twins, triplets, etc.)
- Using fertility treatments
- Problems with the placenta Eclampsia (a serious condition involving seizures during pregnancy)
- Having too much amniotic fluid (polyhydramnios)
- Tears in the cervix (cervical lacerations)
- Uterine rupture
- C-sections or other types of assisted deliveries
Even though these factors may be linked to AFE, there are currently no known risks that would change how doctors normally care for someone during pregnancy and delivery.
Can labor induction cause an AFE?
There has been a lot of interest in whether starting labor with medicine (called induction) might raise the risk of amniotic fluid embolism (AFE). Right now, research doesn’t give us a clear answer. Much of the research uses large data sets instead of reviewing individual medical charts, which makes some people question how accurate the findings are.
The goal of labor induction is to keep both mother and baby safe — not to cause harm. Inducing labor is common today, but it can be a debated topic because, like many medical treatments, it has both risks and benefits.
Some drugs used during labor induction or to treat bleeding after birth list AFE as a possible risk. These drugs are often used off-label, which means they were originally made for other conditions. This also means they weren’t fully tested for use during labor, so we don’t know all the risks.
The AFE Foundation relies on trusted medical groups, like the Society for Maternal-Fetal Medicine (SMFM), American College of Obstetricians and Gynecologists (ACOG), Association of Women’s Health and Neonatal Nurses (AWHONN), and the California Maternal Quality Care Collaborative (CMQCC), for the most up-to-date information.
Deciding to induce labor should be based on each individual case. It’s important that all risks and benefits are explained, and that both the mother and healthcare team agree before moving forward.
Until we have stronger research, the AFE Foundation does not take a stance on whether labor induction causes AFE.
Can I have another child after an amniotic fluid embolism?
Research on pregnancy following amniotic fluid embolism is very limited. The National Institutes of Health released a comprehensive review of amniotic fluid embolism in 2009 and at that time there were nine cases of successful subsequent pregnancies following AFE that did not experience another AFE.
In 2015, a publication from the AFE Foundation Registry reported that 26 out of 80 survivors had successful subsequent pregnancies without recurrence.
The experience of an AFE is a traumatic experience for the mother, their loved ones, and even the healthcare team. Deciding whether to become pregnant again can be a difficult decision.
We advise all women considering a subsequent pregnancy to seek a consultation with a maternal fetal medicine provider. They can review your medical history and provide you with an informed and personalized perspective.
Sometimes a doctor will advise against a future pregnancy because they are unfamiliar with AFE. They may have fear and trepidation in being your physician. Or, they may have strong evidence that a subsequent delivery puts you in a high-risk category.
Even a well-meaning physician may not have the experience to provide you with sufficient advice. We advise speaking with a few specialists to ensure you have the information you need to help make a decision.
Ultimately, it is a personal and individualized decision to make. Having the right healthcare team and support from your loved ones will allow you to feel confident in your decision.
We also recommend seeking counseling from a trained and licensed birth trauma professional. This can help with the mental health challenges surrounding this decision.
If you would like to connect with others who have gone on to have subsequent pregnancies, please join our support group. This group is for support and should not be viewed as medical information or treatment advice.
There is currently no standard of care or protocol for subsequent deliveries of AFE survivors. Each case is unique and should be treated as such.
What can I do to help prevent amniotic fluid embolism?
Amniotic fluid embolism has been known since the 1920s, but doctors still don’t fully understand it. Because we don’t know exactly what causes it or who might be at risk, there is no known way to prevent AFE from happening.
There are still things that can help improve survival if AFE does occur. The most important is making sure a woman gives birth in a hospital that can respond quickly with emergency care. immediate treatment can offer the best chance for survival.
Another way to help is to raise awareness. When more doctors and nurses know about AFE and have practiced their repsonse, they can recognize it faster and start treatment right away. This can help save both the mother and baby.
Research is also very important. We need more studies to learn what causes AFE, how to prevent it, and how to treat it effectively.
The AFE Foundation is working hard to support AFE research, educate healthcare providers, and raise awareness.
If you want to help, you can support the AFE Foundation by donating, spreading awareness, or getting involved in our work.
How can I honor a loved one affected by or lost to an amniotic fluid embolism?
One way to honor a loved one is by making a donation to the AFE Foundation. You can give in their name as a tribute or memorial gift.
Some people also choose to organize fundraising events in honor of their loved one to support the AFE Foundation’s mission. If you’re interested in planning an event, we’re here to help — just reach out to us!
Help us #endAFE!
The AFE Foundation is funded by donations. Every dollar goes toward our support, research, and education programs. We are committed to turning donations into action, including yours.