Amniotic fluid embolism: Analysis of the national registry

pingchi1983

OBJECTIVE: We analyzed the clinical course and investigated possible pathophysiologic mechanisms of
amniotic fluid embolism.
STUDY DESIGN: We carried out a retrospective review of medical records. Forty-six charts were
analyzed for 121 separate clinical variables.
RESULTS: Amniotic fluid embolism occurred during labor in 70% of the women, after vaginal delivery in
1 1%, and during cesarean section after delivery of the infant in 19%. No correlation was seen with
prolonged labor or oxytocin use. A significant relation was seen between amniotic fluid embolism and
male fetal sex. Forty-one percent of patients gave a history of allergy or atopy. Maternal mortality was
61%, with neurologically intact survival seen in 15% of women. Of fetuses in utero at the time of the
event, only 39% survived. Clinical and hemodynamic manifestations were similar to those manifest in
anaphylaxis and septic shock.
CONCLUSIONS: Intact maternal or fetal survival with amniotic fluid embolism is rare. The striking
similarities between clinical and hemodynamic findings in amniotic fluid embolism and both anaphylaxis
and septic shock suggest a common pathophysiologic mechanism for all these conditions. Thus the term
amniotic fluid embolism appears to be a misnomer. (AM J OBSTET GYNECOL 1995;172:1158-69.)
Key words: Amniotic fluid embolism, fetal asphyxia, maternal mortality