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Buechel J, Monod C, Alba Alejandre I, Ninke T, Hoesli I, Starrach T, Delius M, Mahner S, Kaltofen T. Amniotic Fluid Embolism: a comparison of two classification systems in a retrospective 8-year analysis from two tertiary hospitals. J Gynecol Obstet Hum Reprod 2023; 52:102597. [PMID: 37087046 DOI: 10.1016/j.jogoh.2023.102597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Amniotic fluid embolism (AFE) is a rare life-threatening complication in obstetrics, but the diagnosis lacks a consensual definition. The objective of this study was to compare two different AFE classification systems by analysing the AFE cases from two university hospitals. MATERIAL AND METHODS In this retrospective study, all patients with a strong suspicion of AFE between 2014 and 2021 at two university hospitals, LMU Women's University Hospital Munich, and Women's University Hospital Basel, were included. Patient records were checked for the ICD-10 code O88.1 (AFE). Diagnoses were confirmed through clinical findings and/or autopsy. The presence of the diagnostic criteria of the Society of Maternal Fetal Medicine (SMFM) and the AFE Foundation (AFEF) and of a new framework by Ponzio-Klijanienko et al. from Paris, France, were checked and compared using Chi-square-test. RESULTS Within our study period, 38,934 women delivered in the two hospitals. Six patients had a strong suspicion of AFE (0.015%). Only three of six patients (50%) presented with all the four diagnostic criteria of the SMFM/AFEF framework. All six patients met the criteria of the modified "Paris AFE framework". CONCLUSION Using the "Paris AFE framework" based exclusively on clinical criteria can help clinicians to diagnose AFE, anticipate the life-threatening condition of the patient and prepare immediately for best clinical care.
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Affiliation(s)
- J Buechel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - C Monod
- Department of Obstetrics and Antenatal Care, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Medical Faculty, University Basel, Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - I Alba Alejandre
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - T Ninke
- Department of Anesthesiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - I Hoesli
- Department of Obstetrics and Antenatal Care, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland; Medical Faculty, University Basel, Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - T Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - T Kaltofen
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany; Department for Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Wiseman D, Simard C, Yang SS, Koolian M, Abenhaim HA, Lipes J. Echocardiography findings in amniotic fluid embolism: a systematic review of the literature. Can J Anaesth 2023; 70:151-160. [PMID: 36307749 DOI: 10.1007/s12630-022-02343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Amniotic fluid embolism (AFE) is a leading cause of obstetrical cardiac arrest and maternal morbidity. The pathogenesis of hemodynamic collapse is thought to be from right ventricular (RV) failure; however, there is a paucity of data documenting echocardiography findings in this population. We undertook a systematic review of the literature to evaluate the echocardiography findings in patients with AFE. SOURCES We retrieved all case reports and case series reporting AFE in Embase and MEDLINE from inception to 20 November 2021. Studies reporting AFE diagnosed by fulfilling at least one of three different proposed AFE criteria and echocardiography findings during hospitalization were included. Patient and echocardiographic data were retrieved, and univariate logistic regression analysis was performed for outcomes of interest. Bias was assessed using the Joanna Briggs Institute clinical appraisal tool for case series. PRINCIPAL FINDINGS Eighty publications reporting on 84 patients were included in the final review. Fifty-five out of 82 patients with data (67%) showed RV dysfunction, including 11/82 (13%) with biventricular dysfunction; 14/82 (17%) had normal systolic function. No data on RV or left ventricular function were reported for two patients. The presence of RV dysfunction on echocardiography was associated with cardiac arrest (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.39 to 9.67; P = 0.009), and a composite risk of cardiac arrest, maternal death or use of extracorporeal membrane oxygenation (OR, 3.86; 95% CI, 1.43 to 10.4; P = 0.007). A low risk of bias was observed in 15/84 (18%) cases. CONCLUSIONS Right ventricular dysfunction on echocardiography is a common finding in AFE and is associated with a high risk of cardiac arrest. The finding of RV dysfunction on echocardiography may help diagnose AFE and help triage the highest risk patients with AFE. STUDY REGISTRATION PROSPERO (CRD42021271323); registered 1 September 2021.
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Affiliation(s)
- Daniel Wiseman
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Camille Simard
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Stephen S Yang
- Department of Anesthesia, Jewish General Hospital, McGill University, Montreal, QC, Canada
- Division of Critical Care, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Maral Koolian
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Haim A Abenhaim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jed Lipes
- Division of General Internal Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada.
- Division of Critical Care, Jewish General Hospital, McGill University, Montréal, QC, Canada.
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