Abstract

OBJECTIVE
To extend our previous work on AFE in Canada by including stricter criteria for case identification and by examining risks for stillbirth, neonatal mortality and serious maternal and neonatal morbidity.
DESIGN
Population-based cohort study.
SETTING
Canada.
POPULATION OR SAMPLE
In all, 4,508,462 hospital deliveries from fiscal year 1991/92 to 2008/09.
METHODS
To reduce false-positive diagnoses, we restricted our analysis to AFE cases with cardiac arrest, shock or severe hypertension, respiratory distress, mechanical ventilation, coma, seizure, or coagulation disorder. Linkage of maternal and neonatal records, available since 2001/02, enabled us to examine the effects of AFE on neonatal outcomes. Detailed demographic and clinical data facilitated control for a broad array of potential confounding variables.
MAIN OUTCOME MEASURES
Amniotic fluid embolism, in-hospital neonatal death, asphyxia, mechanical ventilation, bacterial sepsis, seizure, nonimmune haemolytic or traumatic jaundice and length of hospital stay.
RESULTS
A total of 292 AFE cases were identified, of which only 120 (40%) were confirmed after applying our additional diagnostic criteria, yielding an AFE incidence of 2.5 per 100,000 deliveries. Of the 120 confirmed cases, 33 (27%) were fatal. Significant modifiable risk factors included medical induction, caesarean delivery, instrumental vaginal delivery, and uterine or cervical trauma. Amniotic fluid embolism was associated with significantly increased risks of stillbirth and neonatal asphyxia, mechanical ventilation, sepsis, seizures and prolonged length of hospital stay.
CONCLUSIONS
Amniotic fluid embolism remains a rare but serious obstetric outcome, with several important modifiable risk factors and major implications for maternal, fetal and neonatal health.

Links

Publisher Full Text

Authors

Kramer MS, Rouleau J, Liu S, Bartholomew S, Joseph KS, Maternal Health Study Group of the Canadian Perinatal Surveillance System

Institution

Department of Pediatrics, McGill University Faculty of Medicine, Montreal, QC, Canada. michael.kramer@mcgill.ca

Source

BJOG : an international journal of obstetrics and gynaecology 119:7 2012 Jun pg 874-9

MeSH

Adult
Asphyxia Neonatorum
Canada
Cohort Studies
Embolism, Amniotic Fluid
Female
Humans
Incidence
Infant Mortality
Infant, Newborn
Jaundice, Neonatal
Length of Stay
Logistic Models
Multivariate Analysis
Pregnancy
Risk Factors
Seizures
Sepsis
Stillbirth

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22530987