Active, ongoing surveillance to document the risk factors and short and long-term outcomes of women and their babies following AFE may be helpful to guide best practice, management, counselling and service planning. Although the case fatality rate is lower than in previously published studies, high rates of hysterectomy, resuscitation, and admission to higher care settings reflect the significant morbidity associated with AFE. ConclusionsĪ coordinated emergency response requiring resource intense multi-disciplinary input is required in the management of women with AFE. Five woman died (case fatality rate 15 %) giving an estimated maternal mortality rate due to AFE of 0.8 per 100 000 women giving birth (95 % CI 0.1 % to 1.5 %). Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % ( n = 6) had a hysterectomy and 85 % ( n = 28) received a transfusion of blood or blood products. Eight women (24 %) conceived using assisted reproduction technology. Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Two (6 %) events occurred at home whilst 46 % ( n = 15) occurred in the birth suite and 46 % ( n = 15) in the operating theatre (location not reported in one case). Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95 % CI 3.5 to 7.2 per 100 000). A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation). MethodsĪ population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes. There has been no national population study of AFE in either country. We would love to hear from you.Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S.Early separation of the placenta from the uterus wall.Hemorrhagic shock in an obstetric patient.Convulsion from the toxic reaction to local anesthetic drugs.Life-threatening hemorrhage due to disseminated intravascular coagulation (DIC).Phase 3 acute renal failure and acute respiratory distress syndrome (ARDS).Phase 2 coagulation disturbances of maternal hemostasis.Phase 1 respiratory and circulatory disorders.All of these occur during labor, cesarean delivery, dilatation, and evacuation, or within 30 min postpartum with no other explanation of findings.Coagulopathy or severe hemorrhage in the absence of other explanations.Four criteria must be present to make the diagnosis of AFE:.Cyanosis: ventilation-perfusion mismatching as a result of pulmonary vascular constriction.A rapid decline in pulse oximetry values or sudden absence or decrease in end-tidal carbon dioxide.Altered mental status, seizures, and coma.The maternal prognosis after amniotic fluid embolism is very poor.Any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation.During the second trimester of pregnancy.It is not a consequence of the “simple” mechanical respiratory obstruction, but a humoral effect causing anaphylactoid reactions or complement activation.Occurs when amniotic fluid, fetal cells, hair, or other debris enters the maternal pulmonary circulation and causes cardiovascular collapse.
Amniotic fluid embolism (AFE) is one of the most catastrophic and life-threatening complications of pregnancy.Table of Contents Amniotic fluid embolism Learning objectives
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