Amniotic fluid embolism - implementation of international diagnosis criteria and subsequent pregnancy recurrence risk.
OBJECTIVES
An international diagnostic criterion for amniotic fluid embolism (AFE) diagnosis has recently been published. Data regarding subsequent pregnancies is scarce. We sought to implement recent diagnostic criteria and detail subsequent pregnancies in survivors.


METHODS
A case series of all suspected AFE cases at a tertiary medical center between 2003 and 2018 is presented. Cases meeting the diagnostic criteria for AFE were included. Clinical presentation, treatment, and outcomes described. Pregnancy outcomes in subsequent pregnancies in AFE survivors detailed.


RESULTS
Between 2003 and 2018 14 women were clinically suspected with AFE and 12 of them (85.71%) met the diagnostic criteria for AFE. Three cases occurred during midtrimester dilation and evacuation procedures, and the remaining occurred in the antepartum period. Of the antepartum cases, mode of delivery was cesarean delivery or vacuum extraction for expedited delivery due to presentation of AFE in 8/9 cases (88.88%). Clinical presentation included cardiovascular collapse, respiratory distress and disseminated intravascular coagulopathy (DIC). Heart failure of varying severity was diagnosed in 75% (9/12) cases. Composite maternal morbidity was 5/12 (41.66%), without cases of maternal mortality. 11 subsequent pregnancies occurred in four AFE survivors. Pregnant women were followed by a high-risk pregnancy specialist and multidisciplinary team if pregnancy continued beyond the early second trimester. Six pregnancies resulted in a term delivery. No recurrences of AFE were documented.


CONCLUSIONS
Use of a diagnostic criterion for diagnosis of AFE results in a more precise diagnosis of AFE. Nevertheless, the accuracy of clinical diagnosis is still high. Subsequent pregnancies were not associated with AFE recurrence.
['Cahan|Tal|T|https://orcid.org/0000-0001-5916-7348', 'De Castro|Hila|H|', 'Kalter|Anat|A|', 'Simchen|Michal J|MJ|']
D000328:Adult D002585:Cesarean Section D004211:Disseminated Intravascular Coagulation D042241:Early Diagnosis D004619:Embolism, Amniotic Fluid D005260:Female D006333:Heart Failure D006801:Humans D007557:Israel D007744:Obstetric Labor Complications D018579:Patient Selection D011247:Pregnancy D011256:Pregnancy Outcome D011264:Pregnancy Trimesters D018566:Pregnancy, High-Risk D012128:Respiratory Distress Syndrome D012189:Retrospective Studies D014620:Vacuum Extraction, Obstetrical
amniotic fluid embolism embolism complications obstetric diagnostic technique obstetrics and gynecology high risk pregnancy