2, 14, 15 One plausible alternative hypothesis includes maternal exposure to fetal antigen that triggers complex physiologic derangements, including the activation of proinflammatory mediator systems. 2, 14, 15 However, this assumption has been challenged for a variety of reasons, including the lack of evidence of pulmonary vessel obstruction in many cases of AFE. 13Īmniotic fluid embolism was first reported nearly a century ago and thought to be secondary to fetal debris occluding maternal pulmonary circulation. 6, 11, 12 Recent evidence also suggests at least one-fifth of all cases of AFE were most likely incorrectly diagnosed (possible overdiagnosis), underscoring the diagnostic challenges surrounding AFE. 2, 4 - 10 These wide ranges are likely attributable to the lack of uniform diagnostic criteria. 1 - 3 The reported incidence ranges from 0.8 to 7.7 per 100 000 births, with similarly wide reports of case mortality ranging from 11% to 43%. 1 Amniotic fluid embolism (AFE), despite its rarity, is a leading cause of maternal mortality that often presents as sudden cardiovascular collapse, respiratory distress, and coagulopathy. Maternal mortality has more than doubled during the past 3 decades in the US, with most recent national estimates of 17.3 maternal deaths per 100 000 live births in 2017. The association between PAS and AFE, which was not previously reported, warrants further investigation. 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.Ĭonclusions and Relevance This contemporaneous, national-level analysis validated previously known risk factors for AFE and confirmed the dismal outcomes of pregnancy complicated by AFE. 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 was 17.0% overall. 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). Among these characteristics, PAS had the largest association with AFE (adjusted odds ratio, 10.01 95% CI, 7.03-14.24).
#Amniotic fluid embolism second pregnancy manual#
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. The cohort-level median patient age was 29 years (IQR, 25-33 years). Results A 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. Associations with other severe maternal morbidity indicators and failure to rescue per clinical and pregnancy characteristics were also assessed. The coprimary outcome was failure to rescue, defined as maternal mortality after AFE. Main Outcomes and Measures The primary outcome was clinical, pregnancy, and delivery characteristics of AFE, assessed with a multivariable binary logistic regression model. Objective To examine the clinical, pregnancy, and delivery characteristics and the maternal outcomes related to AFE in a recent period in the US.ĭesign, Setting, and Participants This 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.
Because of the rarity of AFE, associated risks factors and maternal outcomes have been relatively understudied. Importance Amniotic fluid embolism (AFE) is an uncommon pregnancy complication but is associated with high maternal mortality.
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