Skip to main content

Advertisement

SpringerLink
Log in

From appearance to essence: 10 years review of atypical amniotic fluid embolism

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Amniotic fluid embolism (AFE) is an unpredictable and unpreventable complication of maternity. The presentation may range from relatively subtle clinical events to sudden maternal cardiac arrest. However, the neglected diagnosis of non-classical form of AFE (atypical AFE) is very common. The aim of this study was to examine population-based regional data from Suzhou, China. Based on the analysis of all available case reports, we put forward an outline of atypical AFE and investigate whether any variation identified could be ascribed to methodology.

Methods

Retrospective study from January 2004 to December 2013, 53 cases was identified from the database of Center for Disease Control (CDC) in the city of Suzhou. We investigated the presentations of atypical AFE and maternal characteristics with potential factors underlying AFE. Multiple-regression analysis was used to calculate adjusted odds ratios (ORs) and 95 % confidence intervals (CIs).

Results

The incidence of AFE was 6.91 per 100,000 deliveries (53/766,895). Seventeen deaths occurred, a mortality rate of 32 %. Atypical AFE may as the earlier stage or mild form of AFE, there was no death case in the study with timely remedy. The atypical AFE appear is obstetric hemorrhage and/or pulmonary and renal dysfunction postpartum. Hyperfibrinolysis and coagulopathy may the early laboratory findings of atypical AFE. Atypical and classical AFE shared the same risks, such as advanced maternal age, placental abnormalities, operative deliveries, eclampsia, cervical lacerations, and induction of labor.

Conclusion

Staying alert to premonitory symptoms of AFE is critical to turn it to a remediable disease. Patient complaints such as breathlessness, chest pain, feeling cold, distress, panic, a feeling of nausea, and vomiting should elicit close attention. The management of a suspected episode of amniotic fluid embolism is generally considered to be supportive. Hysterectomy must be performed if there is further progression of symptoms. Due to advances in acute care, mortality has decreased in recent years, highlighting the importance of early detection and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Clark SL (2010) Amniotic fluid embolism. Clin Obstet Gynecol 53(2):322–328. doi:10.1097/GRF.0b013e3181e0ead2

    Article  PubMed  Google Scholar 

  2. Conde-Agudelo A, Romero R (2009) Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol 201 (5):445 e441–e413. doi:10.1016/j.ajog.2009.04.052

  3. Kahyaoglu I, Kahyaoglu S, Mollamahmutoglu L (2009) Factor VIIa treatment of DIC as a clinical manifestation of amniotic fluid embolism in a patient with fetal demise. Arch Gynecol Obstet 280(1):127–129. doi:10.1007/s00404-008-0857-3

    Article  PubMed  Google Scholar 

  4. Yang W, Zhou N, Zhou Y (2000) The clinical analysis of 38 cases with amniotic fluid embolism. Zhonghua fu chan ke za zhi 35(2):75–78

    PubMed  CAS  Google Scholar 

  5. Prosper SC, Goudge CS, Lupo VR (2007) Recombinant factor VIIa to successfully manage disseminated intravascular coagulation from amniotic fluid embolism. Obstetr Gynecol 109(2 Pt2):524–525. doi:10.1097/01.AOG.0000235711.11817.8c

  6. Martin RW (1996) Amniotic fluid embolism. Clin Obstet Gynecol 39(1):101–106

    Article  PubMed  CAS  Google Scholar 

  7. Margarson MP (1995) Delayed amniotic fluid embolism following caesarean section under spinal anaesthesia. Anaesthesia 50(9):804–806

    Article  PubMed  CAS  Google Scholar 

  8. Yang CY, Chou CW, Lin MB, Lin CN, Wang LW, Chen SY, Cheng HM (2004) Recurrent pulmonary embolism in an elderly patient with Cushing’s syndrome, adrenocortical adenoma, pheochromocytoma and prostate adenocarcinoma. J Chin Med Assoc JCMA 67(7):360–365

    PubMed  Google Scholar 

  9. Clark SL, Hankins GD, Dudley DA, Dildy GA, Porter TF (1995) Amniotic fluid embolism: analysis of the national registry. Am J Obstetr Gynecol 172(4 Pt 1):1158–1167 discussion 1167–1159

    Article  CAS  Google Scholar 

  10. Nakagami H, Kajihara T, Kamei Y, Ishihara O, Kayano H, Sasaki A, Itakura A (2014) Amniotic components in the uterine vasculature and their role in amniotic fluid embolism. J Obstetr Gynaecol Res. doi:10.1111/jog.12650

    Google Scholar 

  11. Chen KB, Chang SS, Tseng YL, Chiu TH, Liao CC, Ho M, Huang GS, Li CY (2013) Amniotic fluid induces platelet-neutrophil aggregation and neutrophil activation. Am J Obstetr Gynecol 208(4):318 e311–317. doi:10.1016/j.ajog.2013.01.012

  12. Benson MD (2012) Current concepts of immunology and diagnosis in amniotic fluid embolism. Clin Dev Immunol 2012:946576. doi:10.1155/2012/946576

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kanayama N, Inori J, Ishibashi-Ueda H, Takeuchi M, Nakayama M, Kimura S, Matsuda Y, Yoshimatsu J, Ikeda T (2011) Maternal death analysis from the Japanese autopsy registry for recent 16 years: significance of amniotic fluid embolism. J Obstetr Gynaecol Res 37(1):58–63. doi:10.1111/j.1447-0756.2010.01319.x

    Article  Google Scholar 

  14. Davies S (1999) Amniotic fluid embolism and isolated disseminated intravascular coagulation. Can J Anaesth Journal canadien d’anesthesie 46 (5 Pt 1):456–459. doi:10.1007/BF03012944

  15. Clark SL, Pavlova Z, Greenspoon J, Horenstein J, Phelan JP (1986) Squamous cells in the maternal pulmonary circulation. Am J Obstet Gynecol 154(1):104–106

    Article  PubMed  CAS  Google Scholar 

  16. Knight M, Tuffnell D, Brocklehurst P, Spark P, Kurinczuk JJ, System UKOS (2010) Incidence and risk factors for amniotic-fluid embolism. Obstet Gynecol 115(5):910–917. doi:10.1097/AOG.0b013e3181d9f629

    Article  PubMed  Google Scholar 

  17. Taylor FB, Jr., Toh CH, Hoots WK, Wada H, Levi M, Scientific Subcommittee on Disseminated Intravascular Coagulation of the International Society on T, Haemostasis (2001) Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 86 (5):1327–1330

  18. Lurie S, Feinstein M, Mamet Y (2000) Disseminated intravascular coagulopathy in pregnancy: thorough comprehension of etiology and management reduces obstetricians’ stress. Arch Gynecol Obstet 263(3):126–130. doi:10.1007/s004040050010

    Article  PubMed  CAS  Google Scholar 

  19. Phillips LE, McLintock C, Pollock W, Gatt S, Popham P, Jankelowitz G, Ogle R, Cameron PA, Australian New Zealand, Haemostasis R (2009) Recombinant activated factor VII in obstetric hemorrhage: experiences from the Australian and New Zealand Haemostasis Registry. Anesth Analg 109(6):1908–1915. doi:10.1213/ANE.0b013e3181c039e6

    Article  PubMed  Google Scholar 

  20. Knight M, Fitzpatrick K, Kurinczuk JJ, Tuffnell D (2012) Use of recombinant factor VIIa in patients with amniotic fluid embolism. Anesthesiology 117(2):423. doi:10.1097/ALN.0b013e31825b6c77 author reply 423–424

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the cooperation and support from Women and Children’s Hospital of Suzhou city.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 118 Shizi Street, Suzhou, 215006, Jiangsu, China

    Fangrong Shen, Lu Wang, Weiwen Yang & Youguo Chen

  2. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Fangrong Shen

Authors
  1. Fangrong Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weiwen Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Youguo Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Youguo Chen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shen, F., Wang, L., Yang, W. et al. From appearance to essence: 10 years review of atypical amniotic fluid embolism. Arch Gynecol Obstet 293, 329–334 (2016). https://doi.org/10.1007/s00404-015-3785-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-015-3785-z

Keywords

Search

Navigation