Both pulmonary edema and maternal neurologic injury were significantly more frequent among survivors of typical AFE (P =. Fewer maternal deaths were seen among women with atypical AFE however, given the small number of deaths in the overall population, this difference did not reach statistical significance. Of all women with AFE, 17.6% (13/74) delivered vaginally and 79.7% (59/74) underwent cesarean delivery, of which 32.2% (19/59) were emergent, in response to clinical AFE. Maternal death occurred in 10% of cases of typical AFE. Clinical features and maternal outcomes associated with the occurrence of AFE are presented in Table 3. 05), and 10% (6/59) of women with AFE had placenta previa at term. In all, 66% (49/74) of women with AFE reported a history of atopy, or latex, medication, or food allergy, compared to 31% (4739/15091) of the obstetric population delivered at our hospital over the study period (P <. Racial/ethnic makeup was self-reported as 70% white, 7% Hispanic, 3% Asian, 1% black, and 19% mixed or unspecified. Of all women with AFE, only 2 (3%) had twins. Available demographic and pre-event medical and obstetric features of patients with typical and atypical AFE are described in Tables 1 and and2. Of these, 46% (59/129) met the criteria for typical AFE, 12% (15/129) were considered atypical AFE, 21% (27/129) appeared to represent a different condition, and 22% (28/129) were considered to have an uncertain diagnosis ( Figure 1). Sixteen international cases were included. Of the 136 cases submitted to the registry, 129 had charts available for review. Charts, analyzed by the four authors with expertise in the field of AFE and critical care obstetrics, were categorized as one of the following: No cases originated as medico-legal consultations to authors of the study. All consented individuals were informed that the result of case categorization would not be disclosed to them. 2 All cases were initially identified as survivors or family members of decedents who contacted the Foundation’s website and were invited to submit the medical records through the Foundation to the investigators. Cases identified prior to 1995 and included in the original registry for AFE were excluded. Charts submitted to the registry between August 2013 and September 2017 were reviewed for this descriptive study. 25 The aims of the present study were to analyze the clinical features and outcomes of women in this registry, and to investigate differences in clinical presentation and outcomes between women with typical vs atypical AFE.įollowing Institutional Review Board approval in 2012, an international AFE registry was established at Baylor College of Medicine, (Houston, TX) in collaboration with the Amniotic Fluid Embolism Foundation, (Foundation Vista, CA) and the Perinatology Research Branch of the Division of Intramural Research of the Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/US Department of Health and Human Services (Detroit, MI). 24 When applied to the largest United States-based contemporary international registry for AFE, the diagnostic performance of this criteria set demonstrated a sensitivity of 79.4% and a specificity of 100% for the diagnosis of AFE in 115 enrolled women. ![]() 10, 13– 24, 28ĭiagnostic criteria for the research reporting of AFE have been published to promote uniformity in data collection, validate prior studies, refine the identification of clinical risk factors, and improve treatment strategies for AFE. 10– 12, 21– 23 Studies based on administrative data sets consistently demonstrate both a higher incidence and a lower mortality rate than those based on data from individual chart review, suggesting that former studies likely contain significant numbers of patients with conditions other than AFE. 10, 13– 15, 23– 27 The existence of several differing international criteria for the diagnosis of AFE further compound the challenges of defining risk factors, diagnosis, prognosis, and understanding of the underlying pathophysiology of this disease. In addition, many of the signs and symptoms of AFE overlap with those seen in other obstetric complications. Recognition of the true incidence and mortality rates associated with AFE are confounded by several factors – most importantly, the absence of a definitive “gold standard” diagnostic test. 1– 9 The reported incidence of AFE ranges from 1 in 15,200 to 1 in 53,800 deliveries worldwide. Amniotic fluid embolism (AFE) is a catastrophic obstetric complication typically presenting as a complex sequence of peripartum events that result in cardiovascular collapse and disseminated intravascular coagulation (DIC).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |