Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk
-
Tal Cahan
,
Hila De Castro
Abstract
Objectives
An international diagnostic criterion for amniotic fluid embolism (AFE) diagnosis has recently been published. Data regarding subsequent pregnancies is scarce. We sought to implement recent diagnostic criteria and detail subsequent pregnancies in survivors.
Methods
A case series of all suspected AFE cases at a tertiary medical center between 2003 and 2018 is presented. Cases meeting the diagnostic criteria for AFE were included. Clinical presentation, treatment, and outcomes described. Pregnancy outcomes in subsequent pregnancies in AFE survivors detailed.
Results
Between 2003 and 2018 14 women were clinically suspected with AFE and 12 of them (85.71%) met the diagnostic criteria for AFE. Three cases occurred during midtrimester dilation and evacuation procedures, and the remaining occurred in the antepartum period. Of the antepartum cases, mode of delivery was cesarean delivery or vacuum extraction for expedited delivery due to presentation of AFE in 8/9 cases (88.88%). Clinical presentation included cardiovascular collapse, respiratory distress and disseminated intravascular coagulopathy (DIC). Heart failure of varying severity was diagnosed in 75% (9/12) cases. Composite maternal morbidity was 5/12 (41.66%), without cases of maternal mortality. 11 subsequent pregnancies occurred in four AFE survivors. Pregnant women were followed by a high-risk pregnancy specialist and multidisciplinary team if pregnancy continued beyond the early second trimester. Six pregnancies resulted in a term delivery. No recurrences of AFE were documented.
Conclusions
Use of a diagnostic criterion for diagnosis of AFE results in a more precise diagnosis of AFE. Nevertheless, the accuracy of clinical diagnosis is still high. Subsequent pregnancies were not associated with AFE recurrence.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sheba medical Center (no. 9321-12-SMC).
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2020-0391).
© 2021 Walter de Gruyter GmbH, Berlin/Boston
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Artikel in diesem Heft
- Frontmatter
- Review
- Neonatal lupus erythematosus – practical guidelines
- Original Articles – Obstetrics
- Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester
- Amniotic fluid embolism – implementation of international diagnosis criteria and subsequent pregnancy recurrence risk
- COL1A1, COL4A3, TIMP2 and TGFB1 polymorphisms in cervical insufficiency
- Pregnancy and neonatal outcomes of twin pregnancies – the role of maternal age
- Comparison of maternal third trimester hemodynamics between singleton pregnancy and twin pregnancy
- Daily monitoring of vaginal interleukin 6 as a predictor of intraamniotic inflammation after preterm premature rupture of membranes – a new method of sampling studied in a prospective multicenter trial
- Association between the number of pulls and adverse neonatal/maternal outcomes in vacuum-assisted delivery
- Original Articles – Fetus
- The effect of nuchal umbilical cord on fetal cardiac and cerebral circulation-cross-sectional study
- Recognition of facial expression of fetuses by artificial intelligence (AI)
- Correlation of first-trimester thymus size with chromosomal anomalies
- Fetal intracranial structures: differences in size according to sex
- Original Articles – Neonates
- Antenatal care and perinatal outcomes of asylum seeking women and their infants
- Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation
- Short Communication
- The impact of transfers from neonatal intensive care to paediatric intensive care
- Letter to the Editor
- Differential microRNA expression in placentas of small-for-gestational age neonates with and without exposure to poor maternal gestational weight gain
