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Chapter 7 - Management of Amniotic Fluid Embolism

from Section 2 - Algorithms for Management of the Top Five ‘Direct Killers’

Published online by Cambridge University Press:  06 May 2021

Edwin Chandraharan
Affiliation:
St George's University of London
Sir Sabaratnam Arulkumaran
Affiliation:
St George's University of London
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Summary

Amniotic fluid embolus is the eighth most common cause of all maternal deaths, down one place from the previous edition of this book [2, 5]. At 0.35 per 100 000 maternities (95% CI 0.15–1.39) it has declined from the fourth to the fifth leading cause of direct maternal deaths in the United Kingdom. Maternal case fatality rates are between 11% and 32% in the United Kingdom, Australia and the United States [9, 4, ref surveillance]. There is a fall in case mortality rates which is probably due to high-level supportive care and diagnosis of milder cases [6].

Women who died or who had permanent neurological injury were more likely to present with cardiac arrest (83% vs. 33%, P < 0.001), be from ethnic-minority groups (adjusted odds ratio [AOR] 2.85; 95% CI 1.02–8.00), to have had a hysterectomy (OR 2.49; 95% CI 1.02–6.06) and were less likely to receive cryoprecipitate (OR 0.30; 95% CI 0.11–0.80) [1].

Type
Chapter
Information
Obstetric and Intrapartum Emergencies
A Practical Guide to Management
, pp. 47 - 50
Publisher: Cambridge University Press
Print publication year: 2021

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References

Knight, M, Tuffnell, D, Brocklehurst, P, Spark, P, Kurinczuk, JJ, on behalf of the UK Obstetric Surveillance System. Incidence and risk factors for amniotic fluid embolism. Obstet Gynecol. 2010;115:910–17.Google ScholarPubMed
Knight, M, Nair, M, Tuffnell, D, Shakespeare, J, Kenyon, S, Kurinczuk, JJ (eds) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013–15. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2017.Google Scholar
Roberts, C, Algert, C, Knight, M, Morris, J. Amniotic fluid embolism in an Australian population-based cohort. Br J Obstet Gynaecol. 2010;117:1417–21.CrossRefGoogle Scholar
Kramer, MS, Rouleau, J, Baskett, TF, Joseph, KS; Maternal Health Study Group of the Canadian Perinatal Surveillance System. Amniotic-fluid embolism and medical induction of labour: a retrospective, population-based cohort study. Lancet. 2006;368:1444–8.CrossRefGoogle ScholarPubMed
Centre for Maternal and Child Enquiries (CMACE). Saving mothers’ lives: Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. Br J Obstet Gynaecol. 2011;118 (Suppl. 1):1208.Google Scholar
Howell, C, Grady, K, Cox, C. Managing Obstetric Emergencies and Trauma: The MOET Course Manual, 2nd ed. London: RCOG, 2007.Google Scholar
Conde-Agudelo, A, Romero, R. Amniotic fluid embolism: an evidence-based review. Am J Obstet Gynecol, 2009;201(5):445.e113. Erratum in Am J Obstet Gynecol. 2010;202(1):92.Google Scholar
Tuffnell, D, Knight, M, Plaat, F. Amniotic fluid embolism: An update. Anaesthesia. 2011;66(1):36.CrossRefGoogle ScholarPubMed
Tuffnell, DJ. United Kingdom amniotic fluid embolism register. Br J Obstet Gynaecol. 2005;112:1625–9.CrossRefGoogle ScholarPubMed
Beckett, VA, Knight, M, Sharpe, P. The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study. BJOG. 2017;124(9):1374–81.CrossRefGoogle ScholarPubMed

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