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///2016 Abstract Details
2016 Abstract Details2019-07-15T10:10:51-05:00

Amniotic fluid embolism: a multicenter ten year retrospective study

Abstract Number: F-36
Abstract Type: Original Research

Sharon Orbach-Zinger MD1 ; Shiri shkolnik MD2; Alexander Ioscovich MD3; Alexander Zlotnick MD4; Yehuda Ginosar MD5; Leonid Eidelman MD6

Amniotic fluid embolism: a multicenter ten year retrospective study

BACKGROUND: Amniotic fluid embolism (AFE) is an uncommon obstetric emergency, with considerable fetal and maternal morbidity and mortality. There is a paucity of data regarding clinical factors and management. In our study we aimed to delineate parturient characteristics and outcomes of women parturients suffering from an AFE.

METHODS: This was a ten year multicenter, retrospective study conducted in 4 hospitals in Israel. The total combined delivery rate was 40,000 births a year. All parturients medical files with diagnosed cases of AFE identified according to the ICD guidelines were reviewed in the charts and then each chart reviewed individually to determine eligibility for AFE according to Clark's criteria. The institutional review board of every hospital approved the study.

RESULTS: Sixteen cases of AFE were identified between the years 2005-2015. Nine cases occurred during vaginal delivery (56.%) , 5 cases occurred during a cesarean delivery (31.3%), 1 case in the emergency room (6.25%) and 1 women in the maternal fetal unit before labor (6.25%). Obstetric characteristics included; average age of women was 35.2 +/- 4.8 years, average parity was 2.3 +/-1.8, and average gestational week was 40.5+/-1.2 weeks. All women were healthy except for one women who had gestational diabetes. Three women had polyhydramnious (18.8% ) and 2 women had macrosomia (12.5%). Three women had cervical ripening (18.8%), 3 women had prostaglandin induction (18.8%) ,6 women had artificial rupture of membranes (37.5%), and 10 women received oxytocin (62.5%). Presenting symptoms included : 3- doom (18.8%), 8 shortness of breath (50%), 2 (12.5%) cyanosis, 3 - cardiac arrest (18.8%), 9- fetal bradycardia (56.3%), 6- hypotension (37.5%), 9-loss of consciousness (64.3%), 4- seizure(25%), 1-headache (6.3%),2- bleeding (12.5%). Management included: Average packed cells given was 9.8+/-8.3, average fresh frozen plasma 11.5+/-7.3,cryoprecipitate 21.9+/-11.8, and platelets 14.7+/-10.8. Transesophageal echocardiography was used for diagnosis in 8 parturients (50%). Extracorporeal membrane oxygenation (ECMO) was used in 4 patients (25%) and cardiopulmonary bypass in 1(6.25%). Maternal outcomes included: Thirteen women survived (81.3%); of survivors 1 (8.3%) had major neurological disability, 3 (25%) had minor neurological morbidity. Average baby Apgar at one minute was 4.6+/- 3.4 and at 5 minutes 7.1+/- 3.2.

CONCLUSIONS: Amniotic fluid embolism has significant morbidity and mortality.

SOAP 2016