AMNIOTIC-FLUID EMBOLISM - ANALYSIS OF THE NATIONAL REGISTRY

OBJECTIVE: We analyzed the clinical course and investigated possible p athophysiologic mechanisms of amniotic fluid embolism. STUDY DESIGN: W e carried out a retrospective review of medical records. Forty-six cha rts were analyzed for 121 separate clinical variables. RESULTS: Amniot ic fluid embolism occurred during labor in 70% of the women, after vag inal delivery in 11%, and during cesarean section after delivery of th e infant in 19%. No correlation was seen with prolonged labor or oxyto cin use. A significant relation was seen between amniotic fluid emboli sm and male fetal sex. Forty-one percent of patients gave a history of allergy or atopy. Maternal mortality was 61%, with neurologically int act survival seen in 15% of women. Of fetuses in utero at the time of the event, only 39% survived. Clinical and hemodynamic manifestations were similar to those manifest in anaphylaxis and septic shock. CONCLU SIONS: Intact maternal or fetal survival with amniotic fluid embolism is rare. The striking similarities between clinical and hemodynamic fi ndings in amniotic fluid embolism and both anaphylaxis and septic shoc k suggest a common pathophysiologic mechanism for all these conditions . Thus the term amniotic fluid embolism appears to be a misnomer.