Th ere is no diagnostic test for AFE syndrome. In a high-risk peripartum patient (Table 4 ) or one who has recently undergone termination of pregnancy (with hypertonic saline), the combination of coagulopathy, ARDS, and shock should be considered AFE syndrome until otherwise proven. Th e diff erential diagnosis includes sepsis, particularly due to chorioamniitis, thromboembolic pulmonary embolism, and aspiration pneumonitis. Th e fetus should be delivered emergently to avoid fetal demise. CS may be complicated by excess bleeding, requiring ligation of the uterine arteries and perhaps hysterectomy. Th ere is no specifi c treatment, although both aprotinin and activated protein C, compounds that modulate infl ammation and coagulation, may have some utility [18] . Critical care management should be directed at maintaining oxygen delivery and supporting the heart and circulation with inotropes and vasopressors. Early echocardiography is extremely useful to determine the nature of the cardiac injury (right versus left ventricular failure). Right ventricular failure can be worsened by high levels of positive end-expiratory pressure and vaso pressors and can be managed with milrinone, enoxamone, dobutamine, inhaled nitric oxide, and nebulized prostacyclin. Very large quantities of blood products may be required to control the coagulopathy, and this can result in signifi cant fl uid overload. Early consideration should be given to continuous renal replacement therapy. Although extracorporeal membrane oxygenation may appear to be an ideal approach to cardiopulmonary failure, excess bleeding may limit its application [19] .