Anesthetic management of amniotic fluid embolism -- a multi-center, retrospective, cohort study

Skolnik, Shiri; Ioscovich, Alexander; Eidelman, Leonid A.; Davis, Atara; Shmueli, Anat; Aviram, Amir; Orbach‐Zinger, Sharon

doi:10.1080/14767058.2017.1404024

Cited by 19 publications

(10 citation statements)

References 22 publications

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“…Other studies have found similar rates of placenta previa in women who have experienced AFE. 30,42 In addition, 66% of women with AFE reported a history of atopy, or latex, medication, or food allergy, compared to 34% of the obstetric Original Research population delivered at our hospital over the study period (P < .05). This doubling of reported atopy among case patients suggests that an anaphylactoid reaction may be the inciting event for the cascade of adverse events that characterize AFE.…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 90%

Amniotic fluid embolism syndrome: analysis of the Unites States International Registry

Stafford

Moaddab

Dildy

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Incidence, risk factors, and perinatal morbidity and mortality rates related to amniotic fluid embolism remain a challenge to evaluate, given the presence of differing international diagnostic criteria, the lack of a gold standard diagnostic test, and a significant overlap with other causes of obstetric morbidity and mortality. OBJECTIVE: The aims of this study were (1) to analyze the clinical features and outcomes of women using the largest United States-based contemporary international amniotic fluid embolism registry, and (2) to investigate differences in demographic and obstetric variables, clinical presentation, and outcomes between women with typical versus atypical amniotic fluid embolism, using previously published and validated criteria for the research reporting of amniotic fluid embolism. MATERIALS AND METHODS: The AFE Registry is an international database established at Baylor College of Medicine (Houston, TX) in partnership with the Amniotic Fluid Embolism Foundation (Vista, CA) and the Perinatology Research Branch of the Division of Intramural Research of the NICHD/NIH/DHHS (Detroit, MI). Charts submitted to the registry between August 2013 and September 2017 were reviewed, and cases were categorized into typical, atypical, nonÀamniotic fluid embolism, and indeterminate, using the previously published and validated criteria for the research reporting of AFE. Demographic and clinical variables, as well as outcomes for patients with typical and atypical AFE, were recorded and compared. Student t tests, c 2 tests, and analysis of variance tables were used to compare the groups, as appropriate, using SAS/STAT software, version 9.4.RESULTS: A total of 129 charts were available for review. Of these, 46% (59/129) represented typical amniotic fluid embolism and 12% (15/ 129) atypical amniotic fluid embolism, 21% (27/129) were nonÀamniotic fluid embolism cases with a clear alternative diagnosis, and 22% (28/129) had an uncertain diagnosis. Of the 27 women misclassified as an amniotic fluid embolism with an alternative diagnosis, the most common actual diagnosis was hypovolemic shock secondary to postpartum hemorrhage. Ten percent (6/59) of the women with typical amniotic fluid embolism had a pregnancy complicated by placenta previa, and 8% (5/61) had undergone in vitro fertilization to achieve pregnancy. In all, 66% (49/74) of the women with amniotic fluid embolism reported a history of atopy or latex, medication, or food allergy, compared to 34% of the obstetric population delivered at our hospital over the study period (P < .05). CONCLUSION: Our data represent a series of women with amniotic fluid embolism whose diagnosis has been validated by detailed chart review, using recently published and validated criteria for research reporting of amniotic fluid embolism. Although no definitive risk factors were identified, a high rate of placenta previa, reported allergy, and conceptions achieved through in vitro fertilization was observed.

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Section: Results In the Context Of What Is Knownmentioning

confidence: 90%

Amniotic fluid embolism syndrome: analysis of the Unites States International Registry

Stafford

Moaddab

Dildy

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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“…2 Moreover, a high percentage of survivors had neurological deficits. 3 AFE pathophysiology is not completely understood, but it is likely caused by the entry of fetal antigens and amniotic fluid into the maternal circulation, triggering the release of endogenous inflammatory mediators. 4 These endogenous inflammatory mediators deteriorate the cardiovascular and pulmonary functions and activate the clotting cascade, causing various symptoms.…”

Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report

Adachi

Fujita

et al. 2021

J of Obstet and Gynaecol

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Amniotic fluid embolism (AFE) is a rare but fatal obstetric complication, characterized by sudden cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. Maternal mortality associated with AFE is high, making early recognition and prompt treatment important. In AFE with cardiac arrest, survival following acute cardiopulmonary dysfunction is crucial. In recent years, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has attracted attention as an aggressive treatment for AFE with cardiac arrest. A 40-year-old woman experienced sudden cardiac arrest due to AFE during cesarean section. Cardiopulmonary resuscitation and VA-ECMO (also called percutaneous cardiopulmonary support) were initiated early. Finally, she recovered without any complications. VA-ECMO can provide temporary respiratory and hemodynamic support until cardiopulmonary function improves after a few days in intensive care. VA-ECMO should be considered as an early treatment for AFE with cardiac arrest.

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“…A recent retrospective multicenter study lasting ten years (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) showed that the most common initial symptom of amniotic fluid embolism was a sudden loss of consciousness which was observed in 66.7% of cases, followed by fetal bradycardia (50%) and dyspnea (55%). Typically in 55% of cases a post-mortem caesarean section was performed in the operating room, except for one case, in which the caesarean section was performed at the place of receipt of interest [26]. According to other studies in up to 12% of cases the initial symptom is severe bleeding from a blood clotting disorder which is life threatening to the pregnant woman [27,28].…”

Section: Diagnostic Approachmentioning

confidence: 99%

Amniotic fluid embolism: A rare and destructive obstetric complication

Thanasa¹,

Thanasa²,

Gerokostas³

et al. 2022

Magna Sci. Adv. Res. Rev.

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Amniotic fluid embolism is a rare, unpredictable and often catastrophic obstetric complication that usually occurs during labor or caesarean section. The pathogenetic mechanism has not been fully elucidated to date. Amniotic fluid embolism is believed to happen due to an anaphylactic reaction to embryonic antigens that enter the mother's circulation and trigger a variety of immune processes that produce an anaphylactic-like response. The diagnosis remains clinical. The disease manifests abruptly with cardiovascular shock, encephalopathy, fetal discomfort and disseminated intravascular coagulation. There is no special treatment. The treatment is supportive and focuses on rapid stabilization of the cardiopulmonary system, adequate oxygenation of the vital organs and correction of coagulation, ensuring the best possible perinatal outcome. In this article, based on current data, a literature review of this rare obstetric complication is attempted, particularly with regard to diagnosis and the basic treatment principles, the timely and correct application of which can provide the best possible outcome for the mother and the newborn.

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Anesthetic management of amniotic fluid embolism -- a multi-center, retrospective, cohort study

Abstract: AFE is associated with significant maternal morbidity. This study highlights the importance of providing advanced training for the delivery suite staff for cases of maternal cardiovascular collapse secondary to AFE and increasing awareness for this rare and devastating obstetric condition.

Cited by 19 publications

References 22 publications

Amniotic fluid embolism syndrome: analysis of the Unites States International Registry

Amniotic fluid embolism syndrome: analysis of the Unites States International Registry

Venoarterial extracorporeal membrane oxygenation as an early treatment for amniotic fluid embolism with cardiac arrest: A case report

Amniotic fluid embolism: A rare and destructive obstetric complication

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