[The clinical analysis of 38 cases with amniotic fluid embolism]

To analyze the clinical course of amniotic fluid embolism (AFE) and identify the high risk factors.

Thirty-eight cases diagnosed as AFE in Suzhou region during period of past 15 years were analyzed retrospectively. Fifteen years were divided into 5 stages with 3 years each.

Of 38 cases, 30 (78.9%) were primigravida and one twins. There were 34 maternal deaths. Among them, 31 died in the first four stages and 3 died in the last stage. There were 4 cases survived from AFE in the last stage. AFE accounted for 15% of total maternal deaths in the past 15 years, which is the second cause of maternal death. Of 38 cases, 2 (5.2%) occurred before 28 gestational weeks. 20 (52.6%) suffered from AFE during labour, 13 (34.2%) after delivery, and 3 (7.8%) before labour. All cases presented respiratory distress, cyanosis, chest discomfort and/or shock, cardiopulmonary collapse. Sixteen cases had postpartum hemorrhage and/or laboratory evidence of DIC. Of 38 cases, 15 (39.5%) died within one hour after onset of AFE. The predisposing factors for AFE included strong uterine contractions due to oxytocin or PEG augmented 17 cases (44.7%), pregnancy induced hypertension 11 cases (28.9%), multigravida and/or elder gravida 9 cases (23.7%) and cesarean section 8 cases (21.1%).

AFE must be suspected in maternal cases with sudden collapse, especially the clinical symptoms of allergic reaction. Prevention of hypertonic uterine contraction and prompt resuscitation, and emergency surgical delivery can improve the prognosis of AFE.