<prompt> An elderly multiparous woman with intrauterine foetal death was admitted with strong labour pains. The patient suddenly goes in shock with cyanosis respiratory disturbances and pulmonary oedema. The most likely clinical diagnosis is:Rupture of uterusCongestive heart failureAmniotic fluid embolismConcealed accidental hemorrhage  <response>: In the question, the female is :MultiparousAdvanced maternal ageFetus is dead.The patient is having strong uterine contractions and suddenly goes in shock with cyanosis, respiratory disturbance and pulmonary edema. All these favour the diagnosis of amniotic fluid embolism.Amniotic fluid embolism : It is characterised by an abrupt onset of respiratory distress and coagulopathy.Amniotic fluid enters the circulation and sets up a disseminated intravascular coagulation, leading to consumptive coagulopathy.Classically a woman in late labour or immediate postpartum gasps for air, has bronchospasm, becomes cyanotic and undergoes immediate collapse and cardiorespiratory arrest, usually accompanied by hemorrhage. Sudden death is usual.It is diagnosed clinically.Risk factors:Advanced maternal ageTetanic uterine contractionUterine rupturePremature separation of placentaMultiparityUse of uterine stimulantsCesarean sectionIntra uterine fetal death. 