Risk factors for fatality in amniotic fluid embolism: a systematic review and analysis of a data pool

Indraccolo, Ugo; Battistoni, Caterina; Mastrantonio, Irene; Iorio, Raffaele; Greco, Pantaleo; Indraccolo, Salvatore Renato

doi:10.1080/14767058.2017.1293034

Cited by 10 publications

(6 citation statements)

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“…A study of 227 cases ascertained from a coded national hospital admissions database and a study of just 20 cases ascertained from a regional database with additional criteria to exclude false positive cases both found no significant association between various sociodemographic or obstetric-related characteristics and fatality [9,36]. A study that reviewed 44 case reports of AFE found that treatment with factor VIIa was associated with an increased risk of death or permanent disability, while a recent study that reviewed 177 case reports of AFE only found a significant association between oxytocin use during labour and fatality amongst typical cases of AFE defined as having the classical triad of symptoms (cardiac arrest/cardiovascular collapse, respiratory failure, coagulopathy) [37,38]. Another study of 180 cases identified from a coded hospital admissions population database found a crude association between induction of labour and fatality [9].…”

Section: Discussionmentioning

confidence: 99%

Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study

et al. 2019

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BackgroundAmniotic fluid embolism (AFE) remains one of the principal reported causes of direct maternal mortality in high-income countries. However, obtaining robust information about the condition is challenging because of its rarity and its difficulty to diagnose. This study aimed to pool data from multiple countries in order to describe risk factors, management, and outcomes of AFE and to explore the impact on the findings of considering United Kingdom, international, and United States AFE case definitions.Methods and findingsA population-based cohort and nested case-control study was conducted using the International Network of Obstetric Survey Systems (INOSS). Secondary data on women with AFE (n = 99–218, depending on case definition) collected prospectively in population-based studies conducted in Australia, France, the Netherlands, Slovakia, and the UK were pooled along with secondary data on a sample of control women (n = 4,938) collected in Australia and the UK. Risk factors for AFE were investigated by comparing the women with AFE in Australia and the UK with the control women identified in these countries using logistic regression. Factors associated with poor maternal outcomes (fatality and composite of fatality or permanent neurological injury) amongst women with AFE from each of the countries were investigated using logistic regression or Wilcoxon rank–sum test. The estimated incidence of AFE ranged from 0.8–1.8 per 100,000 maternities, and the proportion of women with AFE who died or had permanent neurological injury ranged from 30%–41%, depending on the case definition. However, applying different case definitions did not materially alter findings regarding risk factors for AFE and factors associated with poor maternal outcomes amongst women with AFE. Using the most liberal case definition (UK) and adjusting for the severity of presentation when appropriate, women who died were more likely than those who survived to present with cardiac arrest (89% versus 40%, adjusted odds ratio [aOR] 10.58, 95% confidence interval [CI] 3.93–28.48, p < 0.001) and less likely to have a source of concentrated fibrinogen (40% versus 56%, aOR 0.44, 95% CI 0.21–0.92, p = 0.029) or platelets given (24% versus 49%, aOR 0.23, 95% CI 0.10–0.52, p < 0.001). They also had a lower dose of tranexamic acid (median dose 0.7 g versus 2 g, p = 0.035) and were less likely to have had an obstetrician and/or anaesthetist present at the time of the AFE (61% versus 75%, aOR 0.38, 95% CI 0.16–0.90, p = 0.027). Limitations of the study include limited statistical power to examine factors associated with poor maternal outcome and the potential for residual confounding or confounding by indication.ConclusionsThe findings of our study suggest that when an AFE is suspected, initial supportive obstetric care is important, but having an obstetrician and/or anaesthetist present at the time of the AFE event and use of interventions to correct coagulopathy, including the administration of an adequate dose of tranexamic acid, may be important to i...

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Section: Discussionmentioning

confidence: 99%

Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study

et al. 2019

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“…[1,9] Other risk factors that may be associated with AFE include the use of oxytocin, cervical lacerations, uterine rupture, eclampsia, polyhydramnios, and multiple birth. [10][11][12] With amniotic fluid or fetal materials entering the maternal circulation, the pulmonary vessels experience spasms. Hypoxia and decreased left ventricular function occur as a result of pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

A case report of early application of veno-arterial extracorporeal membrane oxygenation in amniotic fluid embolism

Liu

You

et al. 2021

Medicine

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Rationale:Amniotic fluid embolism (AFE) is a rare obstetrical complication and is a leading cause of maternal death in developed countries. Despite the development of supportive therapeutic measures, the mortality rate remains high.Patient concerns:A 38-year-old nulliparous pregnant woman, who underwent in vitro fertilization-embryo transfer, was admitted for labor at 37 weeks’ gestation. Approximately 30 minutes after delivery of the placenta, the puerpera developed postpartum hemorrhage with uterine atony. Soon after, the patient experienced hypotension, repeated cardiac arrest, refectory hypoxia, and disseminated intravascular coagulopathy.Diagnosis:AFE is diagnosed clinically. The pregnant woman in this case fulfilled the diagnostic criteria for AFE: acute hypotension, cardiac arrest, acute hypoxia, and coagulation disorders within approximately 30 minutes after delivery of the placenta.Interventions:The patient was intubated, connected to a ventilator, and was administered a high dose of vasoactive drugs to maintain blood pressure and underwent an emergency hysterectomy. Considering the risk for recurrent cardiac arrest and severe refractory hypoxia, venoarterial extracorporeal membrane oxygenation was initiated and discontinued as soon as cardiac function was restored based on serial bedside ultrasound assessment.Outcomes:The patient stabilized on day 7 in the intensive care unit and was transferred to the obstetrics ward and, 1 week later, was discharged with no complications. Two months later, follow-up revealed that the patient was in good condition.Lesson:Serial bedside ultrasound was crucial for assessing cardiac function and optimal weaning. Timely application of venoarterial extracorporeal membrane oxygenation and weaning was significant to avoid the occurrence of complications and improve long-term outcomes.

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“…The challenges of childbirth, especially when they involve long -term use of oxytocin or a combination of oxytocin and prostaglandins, increase the risk of amniotic fluid embolism [16]. Recently, Indraccolo and colleagues, analyzing the results of a systematic review of amniotic fluid embolism cases from 1990 to 2015 showed that only the injection of oxytocin during the course of labor statistically significantly increases the risk of developing the syndrome [17].…”

Section: Pathogenesismentioning

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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Risk factors for fatality in amniotic fluid embolism: a systematic review and analysis of a data pool

Abstract: Further research on national registries should focus on the behaviour of oxytocin infusion during labour in AFE cases.

Cited by 10 publications

References 19 publications

Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study

Risk factors, management, and outcomes of amniotic fluid embolism: A multicountry, population-based cohort and nested case-control study

A case report of early application of veno-arterial extracorporeal membrane oxygenation in amniotic fluid embolism

Amniotic fluid embolism: A rare and destructive obstetric complication

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