Society for Maternal-Fetal Medicine Special Statement: Checklist for initial management of amniotic fluid embolism

Combs, C. Andrew; Montgomery, Douglas M.; Toner, Lorraine; Dildy, Gary A.

doi:10.1016/j.ajog.2021.01.001

Cited by 17 publications

(36 citation statements)

References 16 publications

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“…It may occur during pregnancy, medical procedures such as amniocentesis, induction of labour, vaginal delivery, cesarean section or postpartum [4,10]. The incidence of the disease is estimated at 1,9-8 per 100,000 pregnancies [4][5][6][7][8][10][11][12][13][14][15]. It is characterized by poor maternal outcome with high fatality rate ranged from 20% to 60%, depending on country's level of development and the timing of the data [8,10,15].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of the disease is estimated at 1,9-8 per 100,000 pregnancies [4][5][6][7][8][10][11][12][13][14][15]. It is characterized by poor maternal outcome with high fatality rate ranged from 20% to 60%, depending on country's level of development and the timing of the data [8,10,15]. Older data indicate a mortality reaching even about 90% [4,7].…”

Section: Discussionmentioning

confidence: 99%

“…Further research is needed to understand the processes that predispose some patients to the development of AFE. Moreover, the diagnosis of AFE is very difficult, and the complication itself resembles other causes of the rapid deterioration of woman' s condition that may occur in the perinatal period, such as: acute pulmonary embolism by thrombus, anaphylaxis, cardiogenic shock, sepsis, air embolism or side effects of anesthetics [10,15]. To accelerate and facilitate the diagnosis of AFE, Society for Maternal-Fetal Medicine (SMFM) and Amniotic Fluid Embolism Foundation have recently proposed four diagnostic criteria: (1) sudden cardiac arrest or cardio-respiratory collapse, (2) clinical onset during labour or within half an hour of placental delivery, (3) DIC and (4) absence of fever (≥38°C) during labour [4,12,16].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, due to the rarity of AFE, health professionals do not have the appropriate experience to effectively treat this obstetric complication. The proper medical treatment is based on emergency cesarean delivery, cardiopulmonary stabilization and maintenance of homeostasis [11,15]. To facilitate medical care, this year the SMSF proposed general guidance in the form of an AFE checklist for initial management [15].…”

Section: Discussionmentioning

confidence: 99%

“…The proper medical treatment is based on emergency cesarean delivery, cardiopulmonary stabilization and maintenance of homeostasis [11,15]. To facilitate medical care, this year the SMSF proposed general guidance in the form of an AFE checklist for initial management [15]. Implementing these guidelines along with running simulations can significantly improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Acute Pulmonary Embolism by Amniotic Fluid – A Rare Complication of Perinatal Period That Should Not Be Forgotten

et al. 2021

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Amniotic fluid embolism (AFE) is a diagnostically challenging type of pulmonary embolism that occurs when amniotic fluid enters maternal circulation during delivery or postpartum. This obstetric complication is very rare but characterized by high mortality rate. The main symptoms are dyspnea, cardiovascular collapse, disseminated intravascular coagulation (DIC) and even sudden cardiac death. The aim of the article is to draw attention to AFE as a rare but possible and catastrophic complication of perinatal period. The authors present a 28-year-old woman who was admitted to obstetric ward during the first stage of labour. The patient developed sudden deterioration of her medical state with acute respiratory distress symptoms. An emergency cesarean section was performed, complicated by excessive bleeding. After a detailed assessment of the patient’s condition and evaluation of the results of additional tests, we diagnosed AFE as the cause of the patient’s deterioration. Conclusions: The case study shows how unpredictable, unpreventable and dangerous is AFE. It is still one of the main causes of maternal deaths in developed countries. Four diagnostic criteria proposed by the Society for Maternal-Fetal Medicine (SMFM) may accelerate diagnosis. AFE as a medical emergency, requires immediate multidisciplinary response and aggressive treatment. The initial medical care may be facilitated by the application of the general guidelines recommended by SMFM. The case report also emphasizes the need for further research on this disease, in particular on early detection and prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Acute Pulmonary Embolism by Amniotic Fluid – A Rare Complication of Perinatal Period That Should Not Be Forgotten

et al. 2021

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Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism

et al. 2022

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ImportanceAmniotic fluid embolism (AFE) is an uncommon pregnancy complication but is associated with high maternal mortality. Because of the rarity of AFE, associated risks factors and maternal outcomes have been relatively understudied.ObjectiveTo examine the clinical, pregnancy, and delivery characteristics and the maternal outcomes related to AFE in a recent period in the US.Design, Setting, and ParticipantsThis retrospective cohort study examined hospital deliveries from January 1, 2016, to December 31, 2019, from the Healthcare Cost and Utilization Project’s National Inpatient Sample.Main Outcomes and MeasuresThe primary outcome was clinical, pregnancy, and delivery characteristics of AFE, assessed with a multivariable binary logistic regression model. The coprimary outcome was failure to rescue, defined as maternal mortality after AFE. Associations with other severe maternal morbidity indicators and failure to rescue per clinical and pregnancy characteristics were also assessed.ResultsA total of 14 684 135 deliveries were examined, with AFE diagnosed in 880 women, corresponding to an incidence rate of 6.0 per 100 000 deliveries. The cohort-level median patient age was 29 years (IQR, 25-33 years). In a multivariable analysis, (1) patient factors of older age, Asian and Black race, Western US region, pregestational hypertension, asthma, illicit substance use, and grand multiparity; (2) pregnancy factors of placental accreta spectrum (PAS), placental abruption, uterine rupture, polyhydramnios, chorioamnionitis, preeclampsia, fetal growth restriction, and fetal demise; and (3) delivery factors of early gestational age, cervical ripening, cesarean delivery, operative delivery, and manual removal were associated with AFE. Among these characteristics, PAS had the largest association with AFE (adjusted odds ratio [aOR], 10.01; 95% CI, 7.03-14.24). When stratified by the PAS subtypes, more severe forms of PAS had a greater association with AFE (aOR for increta and percreta, 17.35; 95% CI, 10.21-28.48; and aOR for accreta, 7.62; 95% CI, 4.83-12.01). Patients who had AFE were more likely to have coagulopathy (aOR, 24.68; 95% CI, 19.38-31.44), cardiac arrest (aOR, 24.56; 95% CI, 17.84-33.81), and adult respiratory distress syndrome (aOR, 10.72; 95% CI, 8.09-14.20). The failure-to-rescue rate after AFE was 17.0% overall. However, the failure-to-rescue rate exceeded 30% when AFE co-occurred with other severe maternal morbidity indicators: 45.8% for AFE, cardiac arrest, and coagulopathy; 43.2% for AFE, shock, and cardiac rhythm conversion; and 38.6% for AFE, cardiac arrest, coagulopathy, and shock. The failure-to-rescue rate after AFE also exceeded 30% when AFE occurred in the setting of placental pathology: 42.9% for AFE and PAS and 31.3% for AFE and placental abruption.Conclusions and RelevanceThis contemporaneous, national-level analysis validated previously known risk factors for AFE and confirmed the dismal outcomes of pregnancy complicated by AFE. The association between PAS and AFE, which was not previously reported, warrants further investigation.

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Amniotic Fluid Embolism

Dildy,

Belfort,

Clark

2024

Critical Care Obstetrics

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Society for Maternal-Fetal Medicine Special Statement: Checklist for initial management of amniotic fluid embolism

Cited by 17 publications

References 16 publications

Acute Pulmonary Embolism by Amniotic Fluid – A Rare Complication of Perinatal Period That Should Not Be Forgotten

Acute Pulmonary Embolism by Amniotic Fluid – A Rare Complication of Perinatal Period That Should Not Be Forgotten

Association of Pregnancy Characteristics and Maternal Mortality With Amniotic Fluid Embolism

Amniotic Fluid Embolism

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