Amniotic fluid embolism: Analysis of the national registry http://www.ajog.

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Volume 172, Issue 4, Part 1 , Pages 1158-1169, April 1995

Amniotic fluid embolism: Analysis of the national registry☆ Article Tools

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Steven L. Clark, MD, Gary D.V. Hankins, MD, Donald A. Dudley, MD, Gary A. Dildy, MD, T.Flint Porter, MD
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OBJECTIVE: We analyzed the clinical course and investigated possible pathophysiologic mechanisms amniotic fluid embolism.
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STUDY DESIGN: We carried out a retrospective review of medical records. Forty-six charts were analyzed for 121 separate
clinical variables. Create Citation Alert

RESULTS: Amniotic fluid embolism occurred during labor in 70% of the women, after vaginal delivery in 11%, and during
cesarean section after delivery of the infant in 19%. No correlation was seen with prolonged labor or oxytocin use. A significant
relation was seen between amniotic fluid embolism and male fetal sex. Forty-one percent of patients gave a history of allergy or
atopy. Maternal mortality was 61%, with neurologically intact survival seen in 15% of women. Of fetuses in utero at the time of
the ovent, only 39% survived. Clinical and hemodynamic manifestations were similar to those manifest in anaphytaxis and
septic shock.

CONCLUSIONS: Intact maternal or fetal survival with amniotic fluid embolism is rare. The striking similarities between clinical
and hemodynamic findings in amniotic fluid embolism and both anaphylaxis and septic shock suggest a common
pathophysiologic mechanism for all these conditions. Thus the term amniotic fluid embolism appears to be a misnomer.

Keywords: Amniotic fluid embolism, fetal asphyxia, maternal mortality

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☆ Presented by invitation at the Thirteenth Annual Meeting of the American Gynecological and Obstetrical Society, Hot Springs, Virginia,
September 8–10, 1994.

PII: 0002-9378(95)91474-9

© 1995 Published by Elsevier Inc.

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Volume 172, Issue 4, Part 1 , Pages 1158-1169, April 1995

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