Amniotic fluid embolism.
OBJECTIVE
To review the recent literature on amniotic fluid embolism and how it may influence the clinical management and further study of the condition. Morbidity and mortality from amniotic fluid embolism in the international context will be described, given the recent Confidential Enquiries into Maternal Deaths in the United Kingdom and other studies. With this rare condition we need to look for clues as to how to facilitate diagnosis and improve outcomes.


RESULTS
Amniotic fluid embolism continues to be a leading cause of maternal death. There has been a decrease in mortality from amniotic fluid embolism in the UK from 5.1 to 3.7 per million maternities, but it is still the fifth greatest cause of direct maternal death. In France, 13% of deaths are caused by amniotic fluid embolism, the third highest cause. In Singapore, a study of postmortems found that over 30% of direct maternal deaths were caused by amniotic fluid embolism, the most common cause. Case-specific mortality may not be as high as previously thought. The early data from the UK Register of cases show only 16% mortality, although there is significant maternal and neonatal morbidity. Early diagnosis may be the best way to improve outcomes. Case reports suggest that plasma exchange techniques may be helpful after initial resuscitation.


CONCLUSIONS
With a rare condition additions to the literature are sparse. Early consideration of the diagnosis after prompt resuscitation is needed. Further data are needed to advance beyond this.
Tuffnell
Derek J
DJ
Bradford Hospitals NHS Trust, Bradford, UK. derek.tuffnell@bradfordhospitals.nhs.uk
D004619:Embolism, Amniotic Fluid / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D010951:Plasma Exchange; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012151:Resuscitation; D006113:United Kingdom / Q000453:epidemiology