Summary of clinically diagnosed amniotic fluid embolism cases in Korea and disagreement with 4 criteria proposed for research purpose
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ObjectiveThis study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosedby maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteriaby the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomesbetween cases satisfying all 4 criteria and cases with at least 1 missing criterion. MethodsThis study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collectedinformation, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. ResultsThe median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension,respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%,and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability,showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7%of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutesafter delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfyingall 4 criteria and cases with at least 1 missing criterion. ConclusionTwo-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates ofmaternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy betweenthe clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.
Abstract
ObjectiveThis study aimed 1) to investigate the clinical characteristics of amniotic fluid embolism (AFE) cases clinically diagnosedby maternal fetal medicine (MFM) specialists in Korea, 2) to check the disagreement with 4 recently proposed criteriaby the Society for Maternal-Fetal Medicine (SMFM) for research purpose, and 3) to compare maternal outcomesbetween cases satisfying all 4 criteria and cases with at least 1 missing criterion. MethodsThis study included 12 patients clinically diagnosed with AFE from 7 referral hospitals in Korea. We collectedinformation, including maternal age, symptoms of AFE, the amount of transfusion, and maternal mortality. ResultsThe median maternal age was 33 years (range, 28–40 years). Regarding symptoms, cardiovascular arrest, hypotension,respiratory compromise, clinical coagulopathy, and neurologic signs were observed in 41.7%, 83.3%, 83.3%, 100%,and 66.7% of the cases, respectively. Among the 12 cases, 5 women died and 2 suffered severe neurologic disability,showing an intact survival rate of 41.7%. Disagreement with all 4 criteria proposed by the SMFM was found in 66.7%of the cases, due to the lack of criteria for disseminated intravascular coagulation or strict onset time (<30 minutesafter delivery). There was no difference in maternal mortality and the amount of transfusion between cases satisfyingall 4 criteria and cases with at least 1 missing criterion. ConclusionTwo-thirds of clinically confirmed AFE cases did not satisfy all 4 criteria proposed by the SMFM, despite similar rates ofmaternal mortality with cases satisfying all 4 criteria. Our study suggests that there may be some discrepancy betweenthe clinical diagnosis of AFE and the recent diagnostic criteria proposed by the SMFM for research purpose.
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