Amniotic fluid embolism

• this is a very rare complication of pregnancy, occurring at 4.3 per million pregnancies. Ten deaths due to amniotic fluid embolism occurred in the period 1991-3. This represents 7.8% of direct maternal deaths reported during this period. Maternal age over 25 years is an apparent risk factor (1). No association between amniotic fluid embolism and parity has been observed (1)
  
  
• previously induction or augmentation of labour was thought to be a risk factor for the development of amniotic fluid embolism. However in the period 1991-3 only two cases were associated with augmentation of labour and only one case was associated with induction of labour
  
  
• clinical features
  • sudden collapse, rapidly followed by cyanosis and the development of coagulopathy and bleeding
    
    
• this condition is associated with a mortality rate of up to 80%

In the UK from 2005 to 2010 the rate of fatal AFE in the UK was (3):

• 0.38/100 000 deliveries, 95% CI 0.22 - 0.61; RR 4.93, 95% CI 1.94 - 12.51, P=0.003

Reference:

• HMSO (1996). Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1991-93.
• Conde-Agudelo A, Romero R. Amniotic fluid embolism: an evidencebased review. Am J Obstet Gynecol 2009;201(5):445.e1-13.
• Kristufkova A, Borovsky M, Korbel M, Knight M.Amniotic fluid embolism - Investigation of fatal cases in Slovakia in the years 2005-2010 compared with fatal cases in the United Kingdom. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013 Sep 27.