Nonfatal amniotic fluid embolism. Three possible cases and a new clinical definition

Benson, Michael D.

doi:10.1001/archfami.2.9.989

Cited by 51 publications

(21 citation statements)

References 25 publications

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“…The delayed reaction caused by the slow-reacting substance of anaphylaxis has been well established and the mechanism was considered to also be the cause of AFE pathophysiology. Benson [12] stated that the initial criteria of AFE are symptoms appearing within 48 h of delivery. Margarson [13] and Malhotra et al [14] reported that AFE syndrome could have a delayed presentation, as late as 90 min and 4 h after delivery, respectively.…”

Section: Discussionmentioning

confidence: 99%

Fatal Factors of Clinical Manifestations and Laboratory Testing in Patients with Amniotic Fluid Embolism

Naruse

Noguchi

et al. 2010

Gynecol Obstet Invest

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Aims: To identify factors leading to fatality of patients with amniotic fluid embolism (AFE). Methods: Patients who had fatal or nonfatal AFE were registered at the Hamamatsu University School of Medicine in the Department of Obstetrics and Gynecology from 1992 to 2006. Data collected included information about demographics and clinical characteristics. The fatal factors among these data were identified using χ² analysis and the Mann-Whitney test. Results: One hundred and thirty-five patients met the criteria, which included fatal (n = 65) and nonfatal AFE (n = 70). Maternal full-term gestational weeks, multiparous and noncesarean sections were the risk factors for death found in this study (p < 0.01). Sialyl Tn levels (mean ± SD) in the serum of patients with fatal AFE (69.7± 126.4 U/ml) were higher compared to those with nonfatal AFE (48.3± 161.8 U/ml; p = 0.003). Each of three items (cardiac arrest, dyspnea or loss of consciousness) was more common in fatal AFE (p < 0.01). Maternal pregnancy and labor complications were not associated with the distinction between fatal and nonfatal AFE. Conclusion: Factors associated with patients with fatal AFE were identified. These included multiparity, noncesarean section at full-term and the three symptoms mentioned above. Sialyl Tn levels could be a possible prognostic fatality factor.

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Section: Discussionmentioning

confidence: 99%

Fatal Factors of Clinical Manifestations and Laboratory Testing in Patients with Amniotic Fluid Embolism

Naruse

Noguchi

et al. 2010

Gynecol Obstet Invest

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“…In a small percentage of women this exposure causes a pathological complex resulting, in many cases, in the death of the patient. The clinical variability of the onset of AFE can be compared with the antigenic variability of the amniotic fluid and with individual reactions similar to other anaphylactic or anaphylactoid reactions [1,38]. A hypothesis has been put forward that AFE may have an underlying immunologic source involving the presentation of pregnancyassociated antigen in the maternal circulation.…”

Section: Discussionmentioning

confidence: 99%

“…Amniotic fluid embolism (AFE) is a rare and severe obstetric emergency with an incidence ranging roughly from 1/600 to 1/120,000, but the best estimate of 1/20,000 pregnancies comes from a population based study using hospital discharge diagnoses [1][2][3]. Traditionally thought to be 90% fatal, with maternal survival casting doubt upon the diagnosis, the population-based study found a mortality rate of 26% [3,4].…”

Section: Introductionmentioning

confidence: 99%

Complement C3a expression and tryptase degranulation as promising histopathological tests for diagnosing fatal amniotic fluid embolism

et al. 2009

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To date, the most recent specific diagnostic investigations for amniotic fluid embolism have been unable to conclusively identify any mechanism of disease other than a physical block to the circulation. We selected eight fatal cases in previously healthy women with uneventful singleton term pregnancies who presented to tertiary care centers in Italy for delivery. Pathologic features were assessed immunohistochemically using anti-fibrinogen, anti-tryptase, anti-C(3a), and anti-cytokeratin antibodies. AE1/AE3 cytokeratin stains proved positive, and tryptase-positive material was documented outside pulmonary mast cells. In all studied cases, expression of complement C(3a) was twofold lower than in the control group, suggesting a possible complement activation in AFE, initiated by fetal antigen leaking into the maternal circulation.

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“…Investigaciones sugieren un mecanismo fisiopatológico que consiste en una respuesta inmune materna frente a los antígenos fetales, de tipo anafiláctico [35][36][37].…”

Section: Muerte Secundaria a Embolismosunclassified

Muerte por establecer y muerte súbita

Villa

2017

Colomb. forense

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Resumen.Propósito: este artículo se elaboró para crear conciencia en el campo forense sobre la importancia de conceptualizar claramente las muertes por establecer, aportando diferentes artículos vigentes disponibles, tomando lo más relevante y llevándolo a un contexto real. Periodo que se abarcó, origen y tipos de publicaciones: se realizó una búsqueda en bases de datos y en literatura descrita en libros forenses con información relevante sobre las muertes por establecer, tomando en cuenta un periodo entre 1908 y la actualidad con temas referentes a la muerte sú-bita en el ámbito forense y en el ámbito clínico médico. Punto de vista: en medio de la investigación forense nos vemos enfrentados a las muertes por establecer, que muchas veces son el talón de Aquiles de los investigadores forenses; la concepción y el concepto de la muerte por establecer deben estar claros desde el inicio del abordaje de caso; e incluso desde la escena de los hechos se debe tener claridad acerca de cómo se debe abordar y así determinar las causas y la manera de muerte con base en un todo como contexto final. Conclusiones: la muerte por establecer es un tipo de muerte que debe ser abordado de lo general a lo particular con unas bases sólidas, partiendo de la concepción clara del forense que asume el caso, el abordaje con metodología y progresión en pasos ordenados descritos con detalle en el protocolo de autopsia, hasta la elaboración de una conclusión.Palabras clave: muerte súbita, forense, establecer, desconocido, no identificado.

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Nonfatal amniotic fluid embolism. Three possible cases and a new clinical definition

Cited by 51 publications

References 25 publications

Fatal Factors of Clinical Manifestations and Laboratory Testing in Patients with Amniotic Fluid Embolism

Fatal Factors of Clinical Manifestations and Laboratory Testing in Patients with Amniotic Fluid Embolism

Complement C3a expression and tryptase degranulation as promising histopathological tests for diagnosing fatal amniotic fluid embolism

Muerte por establecer y muerte súbita

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