#DIC AMNIOTIC FLUID EMBOLISM SERIES#

The maternal mortality ratio associated with AFE ranged between 0.5–1.7 deaths per 100,000 live births or deliveries (0.5 for Sweden and the United Kingdom, 0.7 for Canada, 1.5 for Australia, and 1.0–1.7 for the United States). Additional research will be needed to evaluate why the incidence of AFE is over 3 times higher in North America than in Europe. On the other hand, it is possible that AFE is over-diagnosed for medicolegal reasons, since this complication is widely considered to be an unavoidable cause of maternal death. The true incidence of AFE, however, is difficult to determine because the diagnosis of this syndrome remains one of exclusion, with possible underreporting of nonfatal cases. 38, 42, 43 There were no available data on incidence of AFE in other regions of the world. 43 Based on those studies, the pooled estimated incidence of AFE would be 1 in 15,200 deliveries (95% confidence interval, 1 in 13,900 to 1 in 16,700 deliveries) in North America 24, 36, 40 and 1 in 53,800 deliveries (95% CI, 1 in 48,800 to 1 in 59,900 deliveries) in Europe. Details of these studies are provided in the supplementary appendix (available online at According to recent large population-based studies, 24, 36, 38, 40, 42, 43 the incidence of AFE, which includes both fatal and nonfatal cases, ranges between 1 in 12,953 deliveries in the United States, 40 to 1 in 56,500 in the United Kingdom. 6 Forty studies 2, 6– 44 had data on the incidence of AFE and/or associated maternal and perinatal mortality around the world. In 1941, Steiner and Lushbaugh, 2 based on the occurrence of 3 cases of fatal AFE in the first 24,200 deliveries at the New Chicago Lying-In Hospital, estimated the incidence of AFE to be about 1 in 8000 deliveries (maternal mortality ratio of 12.4 deaths per 100,000 deliveries), but subsequently realized that this was an overestimation since no more cases were observed in the next 26,000 deliveries (corrected maternal mortality ratio of 6.0 deaths per 100,000 deliveries). This review critically examines, from the best available evidence, the current knowledge regarding the epidemiology, pathogenesis, pathophysiology, diagnosis, and treatment of AFE.

Moreover, several aspects on this condition remain a subject of controversy.

#DIC AMNIOTIC FLUID EMBOLISM SERIES#

3 Evidence on AFE, however, has been mainly based on individual case reports, autopsy series, or uncontrolled case series due to the low frequency of the condition. Understanding of the pathogenesis of AFE has increased substantially in the last two decades since this disorder was recognized as 1 of the main causes of maternal mortality in the United States. The presence of fetal debris in the pulmonary blood vessels of a mother who had died suddenly in labor was first described by Meyer 1 in 1926, but it was not until 1941 that death following sudden collapse during labor or in the immediate postpartum period was attributed to AFE. Amniotic fluid embolism (AFE) is a rare and often fatal obstetric condition, characterized by sudden cardiovascular collapse, altered mental status, and disseminated intravascular coagulation (DIC).

Dic amniotic fluid embolism