Premium
The Amniotic Fluid Embolism Syndrome: 10 Years' Experience at a Major Teaching Hospital
Author(s) -
Burrows A.,
Khoo S.K.
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb01973.x
Subject(s) - amniotic fluid embolism , medicine , incidence (geometry) , respiratory distress , coagulopathy , pulmonary embolism , shock (circulatory) , amniotic fluid , obstetrics , pediatrics , pregnancy , surgery , fetus , genetics , biology , physics , optics
EDITORIAL COMMENT: Study of causes of maternal deaths and hence prevention of maternal mortality and morbidity requires a high autopsy rate of mothers who die. This is especially true for deaths from amniotic fluid embolism as the clinical signs can be confused with those occurring with pulmonary thromboembolism, Mendelson acid‐aspiration syndrome and rupture of the uterus. In the present study the 2 deaths from amniotic fluid embolism gave a death rate oj'33 7 per 100,000 births whereas in Australia the death rate from amniotic fluid embolism in the 27 years 1964–1990 was 0.90 per 100,000 confinements (table 1A). It may be noted that in the last 18 reported years of statistics from Australia the overall rate of direct maternal deaths has fallen from 23.9 to 6J per 100,000 confinements whereas the comparable figures for amniotic fluid embolism were a fall from 1.43 to 0.63 per 100,000. It is of interest that in the 18 years 1973–1990, amniotic fluid infusion accounted for relatively more direct maternal deaths (10%; 27 of 277) than in the previous 9 years (6%; 31 of 518). In comparison with amniotic fluid embolism there has been a marked reduction in the numbers of maternal deaths and of the death rates from abortion + sepsis (101 to 9), obstructed labour (24 to 2), placenta praevia (21 to 6), abruptio placentae (24 to 9), pulmonary thromboembolism (110 to 43) and preeclampsia/eclampsia (73 to 41). The cause of amniotic fluid embolism remains an enigma even when only those cases with an autopsy‐proven diagnosis are considered. The careful analysis of clinical findings in this series of 9 cases, 7 based upon clinical diagnoses alone, do not support the widely held belief that precipitating factors for amniotic fluid embolism are overactivity of the uterus, multiparity and misuse of oxytocic drugs. It should be noted that in 7 of the 9 women in this study the symptoms and/or signs of amniotic fluid embolism first occurred during or subsequent to Caesarean section or hysterotomy. Summary: A review of the syndrome of amniotic fluid embolism (AFE) was carried out over a 10 year period, 1984–1993, at the Royal Women's Hospital, Brisbane. There were 9 patients with AFE, of whom 2 died – this gave an incidence of fatal AFE of 3.37 per 100,000 pregnancies at the hospital, in comparison with an incidence of 1.03 per 100,000 pregnancies over a 27‐year period in Australia. The study revealed no identifiable risk factors in the characteristics of the patient or her baby, labour and delivery. Three of the patients did not undergo labour and in 4 of the 6 who did, the duration was less than 12 hours. The AFE syndrome could present before, during or after delivery; the common features were shock and respiratory distress, with coagulopathy occurring in 5 patients. Current views of predisposing factors, pathogenesis, diagnosis and management are discussed.