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Amniotic fluid embolism: analysis of the national registry
S L Clark1, G D Hankins, D A Dudley
1Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, USA.
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 11%, 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.