Maternal Death Due to Amniotic Fluid Embolism: A National Study in France

Abstract

(Anesth Analg. 2018;126(1):175–182) Signs and symptoms of amniotic fluid embolism (AFE) vary greatly and are not specific to AFE, making it a difficult condition to diagnose and treat. Recently, the Society for Maternal-Fetal Medicine (SMFM) and the AFE Foundation proposed 4 uniform diagnostic criteria to help identify cases of AFE for research purposes. These criteria have not been tested on a specific population. The authors of the present study applied these criteria to maternal deaths attributed to AFE between 2007 and 2011, as identified by a national experts committee from the French Confidential Enquiry into Maternal Deaths, to evaluate its potential as a diagnostic tool. Furthermore, they described the epidemiology, clinical characteristics, and management of AFE by the presence or absence of all 4 diagnostic criteria.

Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose

“…Given these results, our study is in line with a French national study, including 36 cases of maternal mortality due to AFE, which showed that 41.7% of the cases did not satisfy at least 1 diagnostic criterion [8]. In their study, initial laboratory confirmation of DIC was also the most commonly unsatisfied criterion (28.9%), and the clinical onset time criterion of within 30 minutes after delivery was missed in 5.6% of women [8]. Moreover, according to a recent study by the Amniotic Fluid Embolism Case number of group I was 2, 7, 9, and 10 as shown in Table 2.…”

“…Our results also showed that cases with at least 1 missing criterion manifested fatal maternal outcomes regarding maternal mortality and the amount of transfusion, similar to cases satisfying all 4 criteria. In this regard, we support the French national study that suggested extending the early documentation of DIC criteria of the SMFM to early clinical coagulopathy with bleeding [8].…”

“…Of note, in our study, overall 66.7% of the cases showed neurologic symptoms and 50% (case number 3, 4, 7, 8, 9, 12) showed neurologic symptoms as the first sign, which was the most common symptom. Symptoms of restlessness, confusion, agitation, or numbness have traditionally been considered to support AFE diagnosis [8]. The United Kingdom diagnostic criteria include neurologic signs, such as restlessness, numbness, agitation, and tingling [5].…”

“…However, direct application of these criteria in real clinical circumstances has been questioned [8,9]. In fact, according to a French national study, including 36 women who died of AFE, 41.7% did not satisfy one or more diagnostic criteria presented by the SMFM.…”

“…The most unsatisfied criterion was that the DIC finding should be present after amniotic embolism before a sufficient amount of blood loss. Accordingly, the authors suggested expanding the criteria of early documented DIC proposed by the SMFM, to early clinical coagulopathy with bleeding [8].…”