{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T09:50:28Z","timestamp":1791971428076,"version":"4.3.4"},"reference-count":22,"publisher":"Walter de Gruyter GmbH","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jpm-2025-0161_abs_001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Amniotic Fluid Embolism (AFE) is a rare but catastrophic obstetric emergency characterized by the sudden entry of amniotic fluid or fetal debris into the maternal circulation. This triggers acute cardiopulmonary collapse, disseminated intravascular coagulation (DIC), and multi-organ failure. Despite its low incidence, AFE remains a significant contributor to maternal mortality worldwide. The pathophysiology is poorly understood, involving immune-mediated anaphylactoid reactions and mechanical vascular obstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0161_abs_002\">\n                    <jats:title>Content<\/jats:title>\n                    <jats:p>This review provides a comprehensive synthesis of current knowledge on AFE, examining its epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic challenges, and management strategies. A systematic literature review was conducted following PRISMA guidelines, incorporating peer-reviewed articles and clinical protocols published from 2000 to 2024. Clinical tools such as diagnostic algorithms and resuscitation frameworks were developed from aggregated evidence and thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0161_abs_003\">\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>AFE typically presents intrapartum or in the immediate postpartum period with sudden hypoxia, hypotension, and coagulopathy. Diagnosis is clinical, as no single confirmatory biomarker currently exists. Management is primarily supportive, focusing on rapid resuscitation, hemodynamic stabilization, and aggressive coagulopathy correction. Emerging strategies such as the A-OK regimen (Atropine, Ondansetron, Ketorolac) are discussed as investigational approaches under consideration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jpm-2025-0161_abs_004\">\n                    <jats:title>Outlook<\/jats:title>\n                    <jats:p>AFE continues to challenge obstetric and critical care teams due to its abrupt onset and high fatality. Future priorities include the development of validated diagnostic biomarkers, refinement of therapeutic interventions, and establishment of standardized multidisciplinary response protocols to improve maternal and neonatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jpm-2025-0161","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T06:57:28Z","timestamp":1755845848000},"source":"Crossref","is-referenced-by-count":13,"title":["Amniotic Fluid Embolism: a comprehensive review of diagnosis and management"],"prefix":"10.1515","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-8501","authenticated-orcid":false,"given":"Wiku","family":"Andonotopo","sequence":"first","affiliation":[{"name":"Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Women Health Center , Eka Hospital , Tangerang , Banten , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1710-3909","authenticated-orcid":false,"given":"Muhammad Adrianes","family":"Bachnas","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology , Faculty of Medicine Sebelas Maret University, Dr. Moewardi General Hospital , Solo , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Dewantiningrum","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Women Health Center , Eka Hospital , Tangerang , Banten , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mochammad Besari Adi","family":"Pramono","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Division Division, Department of Obstetrics and Gynecology , Medical Faculty of Diponegoro University, Dr. Kariadi Hospital , Semarang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Setiawan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , UniMedika Hospital , Tangerang , Banten , Indonesia"},{"name":"Indonesian Society of Obstetricians and Gynecologists (ISOG Banten) , Tangerang , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri","family":"Sulistyowati","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology , Faculty of Medicine Sebelas Maret University, Sebelas Maret University Hospital , Solo , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Stanojevic","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Rare Diseases , Medical University of Warsaw , Warsaw , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim","family":"Kurjak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Medical School University of Zagreb , Zagreb , Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"2025122009100255159_j_jpm-2025-0161_ref_001","doi-asserted-by":"crossref","unstructured":"Clark, SL, Romero, R, Dildy, GA, Callaghan, WM, Smiley, RM, Bracey, AW, et al.. Proposed diagnostic criteria for the case definition of amniotic fluid embolism in research studies. Am J Obstet Gynecol 2016;215:408\u201312. https:\/\/doi.org\/10.1016\/j.ajog.2016.06.037.","DOI":"10.1016\/j.ajog.2016.06.037"},{"key":"2025122009100255159_j_jpm-2025-0161_ref_002","doi-asserted-by":"crossref","unstructured":"Knight, M, Tuffnell, D, Brocklehurst, P, Spark, P, Kurinczuk, JJ. Incidence and risk factors for amniotic-fluid embolism. Obstet Gynecol 2017;129:837\u201345. https:\/\/doi.org\/10.1097\/AOG.0000000000001945.","DOI":"10.1097\/AOG.0000000000001945"},{"key":"2025122009100255159_j_jpm-2025-0161_ref_003","doi-asserted-by":"crossref","unstructured":"Tuffnell, DJ. United Kingdom amniotic fluid embolism register. BJOG 2005;112:1625\u20139. https:\/\/doi.org\/10.1111\/j.1471-0528.2005.00755.x.","DOI":"10.1111\/j.1471-0528.2005.00770.x"},{"key":"2025122009100255159_j_jpm-2025-0161_ref_004","doi-asserted-by":"crossref","unstructured":"Steiner, PE, Lushbaugh, CC. 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