Initial testing in patients with suspected amniotic fluid embolism (AFE)

Complete blood count with platelets

Serum electrolytes, blood urea nitrogen, creatinine, calcium, magnesium, phosphate

Liver function tests

Troponin-I

Brain natriuretic peptide (BNP)

Prothrombin time, activated partial thromboplastin time, fibrinogen, D-Dimer

Complement 3 and complement 4

Blood type and antibody screening (if not done at admission)

Serum tryptase*

Plasma and urinary histamine*

Arterial blood gas

Bedside chest radiograph

Electrocardiography

Bedside ultrasonography^¶

Note many of these tests are nonspecific but taken in conjunction with clinical findings help support select diagnoses.

* Serum tryptase (can be elevated in AFE) and histamine are sent to retrospectively diagnose anaphylaxis since reporting is often delayed.
¶ Bedside ultrasonography is not universally available and may include any imaging combination of lower extremity, lung, and abdominopelvic ultrasonography, as well as transthoracic or transesophageal echocardiography.

Graphic 120914 Version 1.0

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Initial testing in patients with suspected amniotic fluid embolism (AFE)