Amniotic Fluid Embolism in an Australian Population-based Cohort

Roberts, CL; Algert, Charles S.; Knight, Marian; Morris, Jonathan M.

doi:10.1097/01.aoa.0000406670.94411.ce

Cited by 23 publications

(52 citation statements)

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“…[1][2][3][4][5][6] The reported incidence of amniotic fluid embolism varies widely with rates varying from 1.9 per 100,000 to 6.1 per 100,000 3,5,10,[32][33][34][35][36][37][38][39][40][41][42] The reported rate appears to be closely related to the data source; series based on detailed review of individual case records generally detect a much lower rate than those based on birth and death certificates or discharge databases. 7,40 In some series, 30-60% of cases originally submitted as amniotic fluid embolism were found, after careful case review by experts, to not meet accepted diagnostic criteria.…”

Section: Incidencementioning

confidence: 99%

“…Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report amniotic fluid embolism as a leading cause of mortality in the pregnant population. [1][2][3][4][5] In addition to its clinical importance, amniotic fluid embolism is a classic example of a condition whose origins were obscured for many years by less-than-rigorous peer review and publication of poor-quality case reports and selective disregard of conflicting data that did not confirm traditional assumptions regarding the pathophysiology of this syndrome. 6,7 Such practices led investigators seeking to understand, prevent, or treat this condition on a wild goose chase for more than half a century.…”

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confidence: 99%

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Amniotic Fluid Embolism

Clark

2014

Obstetrics &Amp; Gynecology

168

129

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Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries and a reported mortality rate ranging from 20% to 60%. The pathophysiology appears to involve an abnormal maternal response to fetal tissue exposure associated with breaches of the maternal-fetal physiologic barrier during parturition. This response and its subsequent injury appear to involve activation of proinflammatory mediators similar to that seen with the classic systemic inflammatory response syndrome. Progress in our understanding of this syndrome continues to be hampered by a lack of universally acknowledged diagnostic criteria, the clinical similarities of this condition to other types of acute critical maternal illness, and the presence of a broad spectrum of disease severity. Clinical series based on population or administrative databases that do not include individual chart review by individuals with expertise in critical care obstetrics are likely to both overestimate the incidence and underestimate the mortality of this condition by the inclusion of women who did not have amniotic fluid embolism. Data regarding the presence of risk factors for amniotic fluid embolism are inconsistent and contradictory; at present, no putative risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of this condition. Maternal treatment is primarily supportive, whereas prompt delivery of the mother who has sustained cardiopulmonary arrest is critical for improved newborn outcome.

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Section: Incidencementioning

confidence: 99%

mentioning

confidence: 99%

Amniotic Fluid Embolism

Clark

2014

Obstetrics &Amp; Gynecology

168

129

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“…In the study of Sakuma et al [69] the incidence of PE associated with pregnancy and/or delivery was 0.8% of the total cases of pulmonary embolism and about one half of these cases was due to AFE. More recently, Knight et al [77] performed a population-based cohort study in the United Kingdom by reporting an AFE incidence of 2.0 per 100,000 deliveries, similar to the 3.3 per 100,000 reported in an Australian population-based study [78]. In the previously published study of Kramer et al [79], which analyzed 3 million hospital deliveries in Canada between 1991 and 2002, higher incidences of 14.8 per 100,000 multiplebirth deliveries and 6.0 per 100,000 singleton deliveries were reported.…”

Section: Amniotic Fluid Embolismmentioning

confidence: 66%

Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism

Montagnana

Cervellin

Franchini

et al. 2010

J Thromb Thrombolysis

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Non-thrombotic pulmonary embolism (NTPE) is commonly defined as the partial or total occlusion of the pulmonary circulation caused by a variety of non-thrombotic embolic agents. Although its prevalence is much lower than that of pulmonary thromboembolism, this life-threatening pathology is often underestimated due to the low specificity of signs and symptoms and because it might be frequently overlooked in the differential diagnosis of the chest pain. The main sources of non-thrombotic pulmonary emboli include cancers, fat, infective agents, amniotic fluid, a variety of foreign materials and gases. The diagnosis is particularly challenging. The spectrum of imaging findings using imaging techniques such as computed tomography is unpredictable and typically heterogeneous, whereas laboratory tests can only be helpful for establishing the cause but not the presence of the disease (i.e., D-dimer testing is frequently negative). As such, the clinical history along with the identification a potential underlying disease are the often the mainstay for the differential diagnosis. The aim of this article is to provide an overview of the pathophysiology, clinics and diagnostic approach to NTPE.

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“…Of the registered cases, maternal mortality was 61% in the USA in 1995 (Clark et al 1995). Recent reports showed that maternal fatality rate was 35%, 27%, 20% and 11% in Australia (Roberts et al 2010), Canada , UK ) and the Netherlands (Stolk et al 2012), respectively. Decreasing rates of mortality likely refl ect early recognition and high-quality aggressive supportive care (Rudra et al 2009).…”

Section: Incidence and Case Fatality Rate Of Afementioning

confidence: 99%

Incidence, diagnosis and pathophysiology of amniotic fluid embolism

Ito

Akasaka

Koike

et al. 2014

Journal of Obstetrics and Gynaecology

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Amniotic fluid embolism (AFE) is a rare clinical entity, sometimes fatal. A review was conducted to describe the frequency, diagnosis and pathophysiology of AFE. The reported incidences ranged from 1.9 cases per 100,000 maternities (UK) to 6.1 per 100,000 maternities (Australia), which can vary considerably, depending on the period, region of study and the definition. Although the development of amniotic fluid-specific markers would have an impact on early diagnosis, definition of AFE based on these markers is not widely accepted. To date, immunological mechanisms, amniotic fluid-dependent anaphylactic reaction and complement activation, have been proposed as potential pathogenetic and pathophysiological mechanisms. Immune cell activation induced through complement activation may be associated with the mechanism that immediately initiates maternal death, only in susceptible individuals. This review will focus on advances in the field of AFE biology and discuss the prevalence, diagnosis and pathophysiology of AFE.

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Amniotic Fluid Embolism in an Australian Population-based Cohort

Cited by 23 publications

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Amniotic Fluid Embolism

Amniotic Fluid Embolism

Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism

Incidence, diagnosis and pathophysiology of amniotic fluid embolism

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