Amniotic Fluid Embolism

About this case

A 27-year-old in active labour at 38 weeks collapses suddenly with profound hypoxia, hypotension, and fetal bradycardia. AFE is a diagnosis of exclusion, so the examiner is testing how you reason toward it while resuscitating, not whether you can name it.

Key clinical features

• AFE — Classic Triad

  Hypoxia + hypotension + DIC in laboring patient, no other cause identified

• Biventricular Failure

  Echo: RV massively dilated, LV hyperdynamic — classic AFE hemodynamics

• DIC

  Fibrinogen undetectable, INR 4.2, platelets crashing — obstetric hemorrhage risk

• Perimortem C-Section Decision

  Fetal bradycardia 60s sustained — perimortem cesarean at 4 minutes if no ROSC

What the examiner is testing

• Whether you can resuscitate and build a differential simultaneously, excluding other causes of peripartum collapse.
• Your recognition of the coagulopathy as part of the syndrome rather than a separate later problem.
• How you approach the perimortem caesarean decision, including the timing that drives it.
• Your grasp of the biventricular failure pattern and why it changes resuscitation priorities.

Where candidates lose points

• Naming AFE immediately without demonstrating you excluded the alternatives.
• Managing the arrest well but treating the DIC as an afterthought.
• Hesitating on the perimortem caesarean decision past the window in which it helps.

How it is scored

Every BoardSim case is scored across the same five phases — pre-operative evaluation, anaesthetic plan, intra-operative management, crisis management, and emergence — for a total of 100 points, with a pass set at 70 and no missed critical action. You receive a written report against each phase rather than a single number. Read the scoring methodology.