title: Clinical characteristics of amniotic fluid embolism: an experience of 29 years.
abstract: OBJECTIVE
  The aim of this study was to elucidate the clinical characteristics and risk factors for amniotic fluid embolism (AFE).
  
  
  METHODS
  We performed a retrospective case study analysis of patients using medical records and autopsy records. The diagnosis of AFE was based on the presence of clinical symptoms using Clark's criteria and autopsy results. We analyzed patient records from a 29-year period in three hospitals affiliated with the Nippon Medical School in Japan.
  
  
  RESULTS
  Ten diagnoses of AFE were found in the records. First, we classified AFE patients into two types based on the initial presenting symptoms: post-partum hemorrhage and cardiopulmonary collapse. Fifty percent of the patients initially presented with post-partum hemorrhage and disseminated intravascular coagulation. Most were diagnosed with post-partum hemorrhage or uterine atony at AFE onset. Similarly, 50% presented with cardiopulmonary arrest or pulmonary arrest as initial symptoms, and most were diagnosed with eclampsia. Second, risk factors for AFE included advanced maternal age, multiparity, increased intrauterine pressure and disruptions of the uterine vasculature. Third, the case fatality rate was 70%. Fourth, squamous cells were observed in maternal central venous blood of five patients.
  
  
  CONCLUSIONS
  AFE patients were classified into two types based on presenting signs and symptoms. Knowledge of the various initial symptoms of AFE enables a correct diagnosis.
authors: Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan.
authors: Koichi
authors: K
authors: Yoneyama
authors: Atsuko
authors: A
authors: Sekiguchi
authors: Takashi
authors: T
authors: Matsushima
authors: Rieko
authors: R
authors: Kawase
authors: Akihito
authors: A
authors: Nakai
authors: Hirobumi
authors: H
authors: Asakura
authors: Toshiyuki
authors: T
authors: Takeshita
mesh_terms: D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D004619:Embolism, Amniotic Fluid / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D008428:Maternal Mortality; D054238:Perinatal Mortality; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
keywords: amniotic fluid embolism; eclampsia; maternal death; maternal mortality; post-partum hemorrhage