Amniotic fluid embolism as an immunocoagulatory catastrophic anaphylactoid syndrome
A. R. Oskolkova,
A. R. Khisamieva,
V. O. Bitsadze,
J. Kh. Khizroeva,
N. A. Makatsariya,
M. V. Tretyakova,
N. R. Gashimova,
K. N. Grigoreva,
O. Yu. Panfilova,
J.-Ch. Gris,
I. Elalamy,
G. Gerotziafas,
E. D. Makatsariya https://doi.org/10.17749/2313-7347/ob.gyn.rep.2026.725
Abstract
Amniotic fluid embolism (AFE) is a rare, life-threatening obstetric complication, known in modern terminology as anaphylactoid syndrome of pregnancy (ASP). ASP is an acute reaction triggered by the penetration of amniotic fluid (containing fetal cells, meconium, tissue factor, etc.) into the maternal circulatory system. This leads to a cascade of pathological reactions comprising the classic triad of fetal hypoxia: acute hypoxia (dyspnea, cyanosis), circulatory collapse (shock, cardiac arrest), and coagulopathy (bleeding). Fetal hypoxia is a diagnosis of exclusion; its treatment is aimed at combating the three main threats: respiratory failure, hemodynamic collapse, and coagulopathy. The prognosis is extremely grave, with maternal mortality reaching 80–90 %. Perinatal mortality and morbidity are also very high due to acute fetal hypoxia. ASP remains one of the most dangerous and poorly predicted causes of maternal mortality. A high level of physician vigilance, awareness of early symptoms, and immediate initiation of comprehensive resuscitation and intensive care aimed at maintaining oxygenation, hemodynamics, and correcting coagulopathy are crucial. The modern therapeutic approach to the syndrome as an anaphylactoid reaction justifies the use of high glucocorticosteroid doses.
Keywords
amniotic fluid embolism,
AFE,
anaphylactoid syndrome of pregnancy,
ASP,
catastrophic anaphylactoid syndrome,
thrombosis
Supporting agencies: The authors declare no funding
About the Authors
A. R. Oskolkova
Sechenov University
Russian Federation
Russian Federation
Arina R. Oskolkova
8 bldg. 2, Trubetskaya Str., Moscow 119048
A. R. Khisamieva
Sechenov University
Russian Federation
Russian Federation
Azaliia R. Khisamieva
8 bldg. 2, Trubetskaya Str., Moscow 119048
V. O. Bitsadze
Sechenov University
Russian Federation
Russian Federation
Victoria O. Bitsadze - MD, Dr Sci Med, Prof., Professor of RAS.
Scopus Author ID: 6506003478
WoS ResearcherID: F-8409-2017
8 bldg. 2, Trubetskaya Str., Moscow 119048
J. Kh. Khizroeva
Sechenov University
Russian Federation
Russian Federation
Jamilya Kh. Khizroeva - MD, Dr Sci Med, Prof.
Scopus Author ID: 57194547147
WoS ResearcherID: F-8384-2017
8 bldg. 2, Trubetskaya Str., Moscow 119048
N. A. Makatsariya
Sechenov University
Russian Federation
Russian Federation
Nataliya A. Makatsariya - MD, PhD.
WoS ResearcherID: F-84062017
8 bldg. 2, Trubetskaya Str., Moscow 119048
M. V. Tretyakova
Sechenov University
Russian Federation
Russian Federation
Maria V. Tretyakova - MD, PhD.
8 bldg. 2, Trubetskaya Str., Moscow 119048
N. R. Gashimova
Sechenov University
Russian Federation
Russian Federation
Nilufar R. Gashimova - MD, PhD.
8 bldg. 2, Trubetskaya Str., Moscow 119048
K. N. Grigoreva
Sechenov University
Russian Federation
Russian Federation
Kristina N. Grigoreva - MD, PhD.
8 bldg. 2, Trubetskaya Str., Moscow 119048
O. Yu. Panfilova
JSC European Medical Center
Russian Federation
Russian Federation
Olga Yu. Panfilova - MD, PhD.
35 Shchepkina Str., Moscow 129110
J.-Ch. Gris
Sechenov University; University of Montpellier
Russian Federation
Russian Federation
Jean-Christophe Gris - MD, Dr Sci Med, Prof., Foreign Member of RAS.
Scopus Author ID: 7005114260
WoS ResearcherID: AAA-2923-2019
8 bldg. 2, Trubetskaya Str., Moscow 119048; 163 Rue Auguste Broussonnet, Montpellier 34090
I. Elalamy
Sechenov University; Université Privée de Marrakech; Hopital Americain de Paris
France
France
Ismail Elalamy - MD, Dr Sci Med, Prof., Foreign Member of RAS.
Scopus Author ID: 7003652413
WoS ResearcherID: AAC-9695-2019
8 bldg. 2, Trubetskaya Str., Moscow 119048; Km 13, Route d’Amizmiz, Marrakech 42312, Morocco; 55 Rue du Châtea; Neuilly-sur-Seine, Paris 92200
G. Gerotziafas
Sechenov University; Tenon Hospital, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris (AP-HP), France; Faculty of Medicine Sorbonne University; Saint-Antoine Research Center (CRSA), University Institute of Cancerology (UIC)
France
France
Grigoriоs Gerotziafas - MD, Dr Sci Med, Prof., Foreign Member of RAS.
8 bldg. 2, Trubetskaya Str., Moscow 119048; 4 Rue de la Chine, 75020 Paris; 91 Boulevard de l'Hôpital, 75013 Paris; 34 Rue du Crozatier, F-75012 Paris
E. D. Makatsariya
Sechenov University
Russian Federation
Russian Federation
Alexander D. Makatsariya - MD, Dr Sci Med, Prof., Academician of RAS.
Scopus Author ID: 57222220144
WoS ResearcherID: M-5660-2016
8 bldg. 2, Trubetskaya Str., Moscow 119048
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What is already known about this subject?
► Amniotic fluid embolism (AFE) was considered a mechanical obstruction of pulmonary vessels by amniotic fluid elements, identified in animal experiments and clinical observations.
► Traditionally, AFE is characterized by the sudden development of critical hypoxia, severe arterial hypotension, and severe coagulopathy (DIC) during or immediately after labor.
► AFE remains one of the most dangerous causes of maternal mortality, characterized by a fulminant course and difficulty in early diagnosis.
What are the new findings?
► The shift from the term "embolism" to "anaphylactoid syndrome of pregnancy" (ASP) is justified, because systemic response to inflammatory mediators rather than mechanical obstruction plays a key role.
► Similarities between the ASP pathogenesis and septic and anaphylactic shock have been established, where the cascade of reactions is triggered by vasoactive mediators: histamine, bradykinin, and cytokines.
► Monoclonal antibodies have been proposed as specific pathological markers for diagnostics, allowing for the detection of fetal elements in microvessels.
How might it impact on clinical practice in the foreseeable future?
► Identification of risk groups: increased attention should be paid to risk groups to enhance vigilance.
► The introduction of modern laboratory tests (assessing antithrombin III, D-dimer) will ensure a more rapid transition from a "diagnosis of exclusion" to pathogenetically justified ASP confirmation.
► The focus will shift to preventing precipitating factors such as unnecessary oxytocin stimulation and early mediator therapy (e.g., leukotriene inhibitors).
Review
For citations:
Oskolkova A.R., Khisamieva A.R., Bitsadze V.O., Khizroeva J.Kh., Makatsariya N.A., Tretyakova M.V., Gashimova N.R., Grigoreva K.N., Panfilova O.Yu., Gris J., Elalamy I., Gerotziafas G., Makatsariya E.D. Amniotic fluid embolism as an immunocoagulatory catastrophic anaphylactoid syndrome. Obstetrics, Gynecology and Reproduction. 2026;20(1):177-191. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2026.725
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