United Kingdom Amniotic Fluid Embolism Register

Tuffnell, Derek

doi:10.1111/j.1471-0528.2005.00770.x

Cited by 127 publications

(73 citation statements)

References 17 publications

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“…Of the 31 survivors of a UK registry, 12 women experienced cardiac arrest. Of the 13 women who died, seven of their babies survived [83]. Although there is still significant maternal and neonatal morbidity, the vast majority of women will nowadays survive [83].…”

Section: Incidencementioning

confidence: 99%

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Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Incidencementioning

confidence: 99%

“…The incidence of AF embolism (AFE) ranges 1 in 6,000-120,000 pregnancies [81][82][83][84]. AFE usually occurs during the immediate postpartum period [85].…”

Section: Incidencementioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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“…Recently, the prognostic role of cardiac arrest has been emphasized: it seems to be significantly related to fatal outcome and permanent neurological injury, especially in the cases in which it is the first recognized symptom or sign of AFE5. Among survivors, persistent neurological impairment has been reported in 6-61% of women [8]. As pointed out by Fitzpatrick and coll., fatal outcome and permanent neurological injury are significantly related to cryoprecipitate administration, hysterectomy, shorter time interval between the AFE event and hysterectomy and ethnic provenance (black or other minority ethnic groups) [5].…”

Section: Prognosismentioning

confidence: 91%

“…Between 24% and 50% of surviving children suffer from persistent neurological deficits [8]. As compared to AFE being diagnosed before or at delivery, diagnosis of AFE in the postpartum period seems to predispose significantly to perinatal death, need for intensive neonatal care and major complications [5].…”

Section: Epidemiologymentioning

confidence: 99%

Amniotic Fluid Embolism: An Update of the Evidence

Piva¹,

Scutiero²,

Greco³

2016

Med Toxicol Clin Forens Med (5)

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This article reviews the current evidence on amniotic fluid embolism (AFE), focusing on epidemiology, pathogenesis, clinical presentation, diagnosis and treatment. AFE is a rare and life-threatening obstetric condition, occurring in 2 to 8 per 100 000 births. With a mortality of 0.5 to 1.7 deaths per 100,000 deliveries in the developed world and 1.9 to 5.9 deaths per 100,000 deliveries in the developing world, it is among the leading direct causes of maternal death. Furthermore, persistent neurological impairment has been reported in 6-61% of survivors. Even though there is no shared pathogenetic theory for AFE, the transfer of amniotic fluid components in the maternal circulation may lead either to an inflammatory-mediated anaphylactoid response or to complement activation. There is great variability in the presentation of AFE from classical cardiopulmonary collapse with coagulopathy to minor and subclinical presentations. In severe cases, AFE should be distinguished from other acute and life-threatening emergencies, such as pulmonary embolism, myocardial infarction and peripartal cardiomyopathy. Thus, the diagnosis is one of exclusion, very often on post-mortem report. In fact, several diagnostic biomarkers have been proposed, but they have not been established in routine clinical diagnosis. Prompt recognition of the symptoms and immediate interdisciplinary management are pivotal for prognosis. The traditional treatment is supportive and aimed at treating cardiovascular, pulmonary, and coagulation derangements. Recently, novel treatment strategies have been proposed in the field of invasive hemodynamic support and C1 esterase inhibitors represent a potential therapeutic option. However, due to the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, AFE still remains a major clinical challenge. Keywords:Amniotic fluid embolism; Maternal death; Pregnancy; Embolism How this fits in with quality in primary care? What do we know?Amniotic fluid embolism (AFE) is a rare and devastating obstetrical condition characterized by a grim prognosis in terms of survival and morbidity. In the absence of reliable diagnostic markers, the diagnosis is based on the clinical presentation and it is one of exclusion. The traditional treatment is supportive. What does this paper add?This paper reviews recent epidemiological data, current evidence about the pathophysiological mechanisms involved in AFE and focuses on novel treatment strategies.

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“…The incidence of AFE has been estimated to be in 1 in 8000 to 80000 deliveries with reported mortality rates in older reports as high as 60%. However, more recent data suggest lower mortality rates ranging between 27-37% (Clark et al, 1995;Morgan, 1979;Tuffnell, 2005). For unknown reasons, the incidence of AFE is much higher in North America, around 1 in 15000 deliveries, Australia -1 in 30000 deliveries (C. L. Roberts et al, 2010), United Kingdom -1 in 50000 (Abenhaim et al, 2008;Knight et al, 2010;Kramer et al, 2006).…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%