AFE syndrome is a devastating complication that usually occurs within 24 hours of delivery. It manifests with acute severe hypoxic respiratory failure, associated with shock, disseminated intravascular coagulopathy (DIC), confusion, and seizures (Table 3 and Figure 2) . Th e incidence of AFE syndrome is unclear, and reports in the literature vary between 1:8,000 and 1:80,000 deliveries [15] . Th e disease is likely under-reported because of the absence of clear diagnostic criteria. Similarly, the mortality rate with AFE syndrome has been reported to be as high as 85%, and the majority of survivors suff er chronic neurologic defi cit [16] .