Amniotic Fluid Embolism-Reply

From a theoretic viewpoint two basic conditions must exist before amniotic fluid can occur. There must be a tear in the membranes so that amniotic fluid can escape, and there must be open maternal blood vessels via which the amniotic fluid can gain entrance into the maternal circulation. Other factors must contribute, in that these conditions exist to a variable extent at some time during every delivery. Thus Steiner and Lushbaugh¹ observed that six of their eight patients had had unusually powerful or tetanic uterine contractions at some time during labor. They theorized that these powerful contractions "(1) prepared a route for the entrance of the emboli into the maternal uterine sinuses by loosening or tearing the placenta and membranes and (2) then forced the emboli into these channels.... It is difficult to believe them unrelated to the embolism." In perusal of the literature since then, a common denominator