One of the most catastrophic events ever to occur in the history of obstetrics is the dreaded amniotic fluid embolism, or anaphylactoid syndrome of pregnancy.  It is a rare but typically fatal condition that strikes without warning, often impairing or killing two lives at one time. The etiology of AFE is still poorly understood, but it is widely accepted that fetal cells enter the maternal circulation through a connection with amniotic fluid and cause cardiopulmonary collapse. It is postulated that this process is more similar to anaphylaxis than embolism, hence the recent description “anaphylactoid syndrome”. The frightening scenario that accompanies AFE categorically escalates in mere minutes to a horrific scene.  It generally begins with a perfectly normal patient experiencing a perfectly normal labor and delivery who dramatically decompensates in the blink of an eye.  AFE is the stamp of certain death for patients delivering at home or in a center without instant availability and access to multidisciplinary teams of critical support.  It is very difficult to recognize, as the dramatic signs and symptoms easily mimic a myriad of other conditions. Appropriate split second decision making is often the difference between life and death.  This presentation will provide an in-depth examination of the anaphylactoid syndrome of pregnancy and its numerous implications for nurses around the country.  Any intense or life threatening situation stirs up incredible emotion and a profound depth of feelings for care providers.  Links between the science of dealing with AFE and the heart of each and every medical professional caring for patients undergoing this devastating experience will be illustrated.  A broad interdisciplinary communication and teamwork is paramount, and all aspects of treatment and outcomes will be covered in detail. Pathophysiology involved will be taught in an engaging way, and conference participants will be able to differentiate Amniotic Fluid Embolism as a specific “disease” to more of a “cascade of events”. Different scenarios potentially causing AFE and what information nurses need to be aware of will be discussed. Classic presentations and clinical signs will be explored, and a course of action from this particular case study under review will be reviewed step by step to illustrate the incredible coordination required to emergently proceed. Two pertinent case studies will be analyzed and compared, revealing the critical element of time and the role it plays in unraveling this mysterious syndrome. Attention will be given to the emotional status and background of the patient’s family presented during the case study, and the role their faith seems to play in the outcome. Unique challenges are obvious in successfully navigating a positive outcome when suddenly faced with AFE. By presenting a case study at the 2009 AWHONN conference, the hope is to bring awareness, explore solutions, and recognize the deep impact this dramatic situation has on obstetrical units everywhere.