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Canadian Journal of Anaesthesia

, Volume 48, Issue 1, pp 88–98 | Cite as

Amniotic fluid embolus: a review of the literature

  • Sharon DaviesEmail author
Obstetrical And Pediatric Anesthesia

Abstract

Purpose: To review the literature since 1979 to determine the natural history, etiology, diagnosis and potential treatment of amniotic fluid embolus (AFE).

Source: English language articles and books published between June 1976 and June 1998 were identified by a computerized medline search using the title or text word amniotic fluid embolus. This same search strategy was repeated and updated to October 1999 by an independent individual using both Medline and Embase. The search was also expanded to include Science Citation Index listing Morgan’s 1979 review article. All relevant publications were retrieved and their bibliographies were scanned for additional sources.

Principal findings: Randomized controlled trials are not possible with amniotic fluid emboli. The majority of the literature consists of clinical reports combined with occasional limited reviews. Knowledge obtained from these reports suggests that amniotic fluid emboli present as a spectrum of disease that ranges from a subclinical entity to one that is rapidly fatal. Because cases are sporadic and the diagnosis is often unconfirmed, little progress has been made towards understanding its etiology or defining the risk factors. Present management is empirical and directed towards the maintenance of oxygenation, circulatory support and the correction of coagulopathy.

Conclusion: Amniotic fluid embolus continues to be a life-threatening but potentially reversible complication unique to pregnancy. It cannot be predicted nor prevented. Review of the literature reveals that there are no standardized investigational methods or protocols to confirm the diagnosis in suspected cases.

Keywords

Obstet Gynecol Amniotic Fluid Disseminate Intravascular Coagulation Maternal Circulation Placental Abruption 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Passer en revue la littérature depuis 1979 pour déterminer l’histoire naturelle, l’étiologie, le diagnostic et le traitement potentiel d’une embolie amniotique (EA).

Source: Des articles et des livres de langue anglaise, publiés entre juin 1976 et juin 1998, ont été sélectionnés lors d’une recherche informatisée de données médicales en utilisant les titres ou l’expressionamniotic fluid embolus. La même méthode de recherche a été utilisée par un individu indépendant pour obtenir une mise à jour jusqu’en octobre 1999 avec Medline et Embase. La recherche a été étendue au Science Citation Index qui présentait la revue de Morgan de 1979. Tous les articles pertinents ont été retenus et leurs bibliographies examinées pour découvrir des sources supplémentaires.

Constatations principales: Les essais contrôlés et randomisés sur l’embolie amniotique sont impossibles. La plus grande partie de la documentation constituée de résumés cliniques combinés à des revues limitées occasionnelles. Les connaissances dégagées de ces résumés suggèrent que l’embolie amniotique se présente comme de multiples affections allant de l’entité subclinique à la maladie rapidement fatale. Les cas étant rares et le diagnostic souvent non confirmé, peu de progrès ont été réalisés pour mieux en comprendre les causes ou pour définir ses facteurs de risque. Le traitement actuel est empirique et vise à maintenir l’oxygénation, à entretenir la circulation et à corriger la coagulopathie.

Conclusion: L’embolie amniotique est toujours une complication grave mais potentiellement réversible, unique à la grossesse. On ne peut la prévoir ni la prévenir. Une revue de la littérature révèle qu’il n’existe pas de méthode ou de protocole normalisés d’évaluation qui permettent de confirmer le diagnostic chez des cas suspects d’embolie amniotique.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  1. 1.From Department of AnesthesiaMount Sinai Hospital and the University Health NetworkTorontoCanada

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