![]() Substances that can lead to endothelial activation and cause a (bradykinin,histamine,and others) and procoagulant “anaphylactoid reaction hypothesis”,AF contains vasoactive Two current pathogenetic theories for AFE. Veins,lesions of the uterus,or the site of placental attachmentĪnd was once thought to cause a purely mechanical ![]() Amnioticįluid (AF) can enter the maternal circulation via endocervical The pathogenesis of AFE has not been clarified yet. Period seems to predispose significantly to perinatalĭeath,need for intensive neonatal care and majorĬomplications. As compared to AFE beingĭiagnosed before or at delivery,diagnosis of AFE in the postpartum īetween 24% and 50% of surviving children suffer from This datum is still significantly higher than the national Rate of perinatal mortality seemed to range between 7% andģ8%,but it has been recently estimated to be 6.7% in the UK. Kingdom Obstetric Surveillance System (UKOSS) report,maternal mortality rate is even lower and accounts for 0.3 perġ00 000 maternities5. Range between 0.5 to 1.7 deaths per 100,000 deliveries in theĭeveloped world and 1.9 to 5.9 deaths per 100,000 deliveries in the developing world. The case-related maternal mortality is estimated to It is a more frequent cause of death in theĭeveloped countries,while it is not dominant in developing Study,collecting data of 7001438 maternities in the periodīetween 1 February 2005 and 31 January 2014 in the UnitedĪFE is one of the leading causes of death resulting directlyįrom childbirth,as it accounts for 5% to 15% of cases However,a lower incidence (1.7 per 100 000īirths) has been reported in a prospective population-based Provided the fact that reliable data are difficult to obtainĭue to heterogeneous diagnostic criteria,the incidence rate isĮstimated to range from 2 to 8 per 100 000 births in differentĬountries. In this review weĪim to extend our previous work,by summarizing the currentĮvidence concerning epidemiology,pathogenesis,diagnosis,and management for AFE. Systems,which can rapidly progress to cardiac arrest and Generally involving the cardio-respiratory and haematological Is characterized by the sudden onset of maternal compromise ![]() Understood condition that is unique to pregnancy. However, due to the lack of specific diagnostic tests, the difficulty of establishing the diagnosis and excluding competing diagnoses, and the complex treatment required, AFE still remains a major clinical challenge.Īmniotic fluid embolism Maternal death Pregnancy Īmniotic fluid embolism (AFE) is a rare and incompletely Recently, novel treatment strategies have been proposed in the field of invasive hemodynamic support and C1 esterase inhibitors represent a potential therapeutic option. The traditional treatment is supportive and aimed at treating cardiovascular, pulmonary, and coagulation derangements. Prompt recognition of the symptoms and immediate interdisciplinary management are pivotal for prognosis. In fact, several diagnostic biomarkers have been proposed, but they have not been established in routine clinical diagnosis. Thus, the diagnosis is one of exclusion, very often on post-mortem report. ![]() In severe cases, AFE should be distinguished from other acute and life-threatening emergencies, such as pulmonary embolism, myocardial infarction and peripartal cardiomyopathy. There is great variability in the presentation of AFE from classical cardiopulmonary collapse with coagulopathy to minor and subclinical presentations. Even though there is no shared pathogenetic theory for AFE, the transfer of amniotic fluid components in the maternal circulation may lead either to an inflammatory-mediated anaphylactoid response or to complement activation. Furthermore, persistent neurological impairment has been reported in 6-61% of survivors. With a mortality of 0.5 to 1.7 deaths per 100,000 deliveries in the developed world and 1.9 to 5.9 deaths per 100,000 deliveries in the developing world, it is among the leading direct causes of maternal death. AFE is a rare and life-threatening obstetric condition, occurring in 2 to 8 per 100 000 births. This article reviews the current evidence on amniotic fluid embolism (AFE), focusing on epidemiology, pathogenesis, clinical presentation, diagnosis and treatment.
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