title: From appearance to essence: 10 years review of atypical amniotic fluid embolism.
abstract: OBJECTIVE
  Amniotic fluid embolism (AFE) is an unpredictable and unpreventable complication of maternity. The presentation may range from relatively subtle clinical events to sudden maternal cardiac arrest. However, the neglected diagnosis of non-classical form of AFE (atypical AFE) is very common. The aim of this study was to examine population-based regional data from Suzhou, China. Based on the analysis of all available case reports, we put forward an outline of atypical AFE and investigate whether any variation identified could be ascribed to methodology.
  
  
  METHODS
  Retrospective study from January 2004 to December 2013, 53 cases was identified from the database of Center for Disease Control (CDC) in the city of Suzhou. We investigated the presentations of atypical AFE and maternal characteristics with potential factors underlying AFE. Multiple-regression analysis was used to calculate adjusted odds ratios (ORs) and 95 % confidence intervals (CIs).
  
  
  RESULTS
  The incidence of AFE was 6.91 per 100,000 deliveries (53/766,895). Seventeen deaths occurred, a mortality rate of 32 %. Atypical AFE may as the earlier stage or mild form of AFE, there was no death case in the study with timely remedy. The atypical AFE appear is obstetric hemorrhage and/or pulmonary and renal dysfunction postpartum. Hyperfibrinolysis and coagulopathy may the early laboratory findings of atypical AFE. Atypical and classical AFE shared the same risks, such as advanced maternal age, placental abnormalities, operative deliveries, eclampsia, cervical lacerations, and induction of labor.
  
  
  CONCLUSIONS
  Staying alert to premonitory symptoms of AFE is critical to turn it to a remediable disease. Patient complaints such as breathlessness, chest pain, feeling cold, distress, panic, a feeling of nausea, and vomiting should elicit close attention. The management of a suspected episode of amniotic fluid embolism is generally considered to be supportive. Hysterectomy must be performed if there is further progression of symptoms. Due to advances in acute care, mortality has decreased in recent years, highlighting the importance of early detection and treatment.
authors.affiliation: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 118 Shizi Street, Suzhou, 215006, Jiangsu, China.|Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
authors.forename: Fangrong
authors.initials: F
authors.lastname: Shen
authors.affiliation: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 118 Shizi Street, Suzhou, 215006, Jiangsu, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 118 Shizi Street, Suzhou, 215006, Jiangsu, China.
authors.forename: Weiwen
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 118 Shizi Street, Suzhou, 215006, Jiangsu, China. chenyouguo@suda.edu.cn.
authors.forename: Youguo
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000009:adverse effects; D004461:Eclampsia; D004619:Embolism, Amniotic Fluid / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric; D008423:Maternal Age; D015999:Multivariate Analysis; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Amniotic fluid embolism; Classification; Maternal mortality; Presentation